Provider Demographics
NPI:1518947316
Name:CHIROHAB PC
Entity Type:Organization
Organization Name:CHIROHAB PC
Other - Org Name:ALFRED CANAL DC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:E
Authorized Official - Last Name:CANAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-558-1166
Mailing Address - Street 1:711 SCRANTON CARBONDALE HWY
Mailing Address - Street 2:SINIAWA PLAZA II
Mailing Address - City:DICKSON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:18508
Mailing Address - Country:US
Mailing Address - Phone:570-558-1166
Mailing Address - Fax:570-558-1177
Practice Address - Street 1:711 SCRANTON CARBONDALE HWY
Practice Address - Street 2:SINIAWA PLAZA II
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18508
Practice Address - Country:US
Practice Address - Phone:570-558-1166
Practice Address - Fax:570-558-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC0078962111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018880440003Medicaid
TX2516135OtherAETNA
PA818419OtherFIRST PRIORITY HEALTH
PACH1641373OtherBCBS
PACA054403Medicare ID - Type Unspecified