Provider Demographics
NPI:1568415610
Name:SOUTHWESTERN CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:SOUTHWESTERN CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:GIOIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:412-233-3600
Mailing Address - Street 1:801 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-2245
Mailing Address - Country:US
Mailing Address - Phone:412-233-3600
Mailing Address - Fax:412-233-3702
Practice Address - Street 1:801 N STATE ST
Practice Address - Street 2:
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-2245
Practice Address - Country:US
Practice Address - Phone:412-233-3600
Practice Address - Fax:412-233-3702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002241L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007883850001Medicaid
070277OtherHIGHMARK KEYSTONE
5797204OtherAETNA
100345OtherUPMC HEALTH PLAN
070277OtherHIGHMARK KEYSTONE
PA070277Medicare PIN