Provider Demographics
NPI:1518233964
Name:CHERRY TREE CHIROPRACTIC
Entity Type:Organization
Organization Name:CHERRY TREE CHIROPRACTIC
Other - Org Name:CHERRY TREE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:N
Authorized Official - Last Name:DOROBISH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-434-5575
Mailing Address - Street 1:20 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-8917
Mailing Address - Country:US
Mailing Address - Phone:724-434-5575
Mailing Address - Fax:724-434-5576
Practice Address - Street 1:20 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-8917
Practice Address - Country:US
Practice Address - Phone:724-434-5575
Practice Address - Fax:724-434-5576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004648L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012374180003Medicaid
PA120759OtherBLUE SHIELD
PA0012374180003Medicaid
PA651061Medicare PIN