Provider Demographics
NPI:1568426708
Name:NALLIN, PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:NALLIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 LESLIE LN
Mailing Address - Street 2:
Mailing Address - City:HUGHESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18640-2818
Mailing Address - Country:US
Mailing Address - Phone:570-655-1599
Mailing Address - Fax:
Practice Address - Street 1:3910 BIRNEY AVE
Practice Address - Street 2:
Practice Address - City:MOOSIC
Practice Address - State:PA
Practice Address - Zip Code:18507-1516
Practice Address - Country:US
Practice Address - Phone:570-344-7272
Practice Address - Fax:570-344-7272
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003281L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PANA446112Medicare ID - Type Unspecified