Provider Demographics
NPI:1548740731
Name:COTNER CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:COTNER CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:COTNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-447-2534
Mailing Address - Street 1:2271 US HIGHWAY 220
Mailing Address - Street 2:
Mailing Address - City:PENNSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:17756-6325
Mailing Address - Country:US
Mailing Address - Phone:570-447-2534
Mailing Address - Fax:
Practice Address - Street 1:21 KRISTI RD STE 7
Practice Address - Street 2:
Practice Address - City:MUNCY
Practice Address - State:PA
Practice Address - Zip Code:17756-8427
Practice Address - Country:US
Practice Address - Phone:570-447-2534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011392111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty