Provider Demographics
NPI:1497282271
Name:PLEXUS CHIROPRACTIC AND REHABILITATION LLC
Entity Type:Organization
Organization Name:PLEXUS CHIROPRACTIC AND REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:724-961-0678
Mailing Address - Street 1:4508 BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-4745
Mailing Address - Country:US
Mailing Address - Phone:724-961-0678
Mailing Address - Fax:
Practice Address - Street 1:4508 BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-4745
Practice Address - Country:US
Practice Address - Phone:724-961-0678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011228111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty