Provider Demographics
NPI:1518237262
Name:MCGRAW CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MCGRAW CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCGRAW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-629-7900
Mailing Address - Street 1:PO BOX 181
Mailing Address - Street 2:
Mailing Address - City:TANNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18372-0181
Mailing Address - Country:US
Mailing Address - Phone:570-629-7900
Mailing Address - Fax:570-629-7968
Practice Address - Street 1:115 LEARN ROAD
Practice Address - Street 2:
Practice Address - City:TANNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18372-0181
Practice Address - Country:US
Practice Address - Phone:570-629-7900
Practice Address - Fax:570-629-7968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007756L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001960620Medicaid
PA001960620Medicaid
PA069802Medicare UPIN