Provider Demographics
NPI:1568860286
Name:TRAUTMAN CHIROPRACTIC & SPINAL REHABILITATION LLC
Entity Type:Organization
Organization Name:TRAUTMAN CHIROPRACTIC & SPINAL REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:Z
Authorized Official - Last Name:TRAUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-709-7612
Mailing Address - Street 1:1701 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2432
Mailing Address - Country:US
Mailing Address - Phone:724-709-7612
Mailing Address - Fax:724-709-7127
Practice Address - Street 1:1701 3RD ST
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2432
Practice Address - Country:US
Practice Address - Phone:724-709-7612
Practice Address - Fax:724-709-7127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-11
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010356111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025391760001Medicaid