Provider Demographics
NPI:1497757272
Name:SCANLAN, RAYMOND JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:JOSEPH
Last Name:SCANLAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-1169
Mailing Address - Country:US
Mailing Address - Phone:814-472-8130
Mailing Address - Fax:814-472-4928
Practice Address - Street 1:1000 N CENTER ST
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-1169
Practice Address - Country:US
Practice Address - Phone:814-472-8130
Practice Address - Fax:814-472-4928
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC000777L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT28943Medicare UPIN