Provider Demographics
NPI:1558462325
Name:PARK AVENUE CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:PARK AVENUE CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:TARANTO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-254-4868
Mailing Address - Street 1:426 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15902-2511
Mailing Address - Country:US
Mailing Address - Phone:814-254-4868
Mailing Address - Fax:
Practice Address - Street 1:426 PARK AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15902-2511
Practice Address - Country:US
Practice Address - Phone:814-254-4868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009573111N00000X
PADC009574111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017882660001Medicaid
PA108674Medicare PIN