Provider Demographics
NPI:1578721635
Name:BENTLEYVILLE CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:BENTLEYVILLE CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HASCHETS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-239-2225
Mailing Address - Street 1:104 JOHNSTON RD
Mailing Address - Street 2:P.O. BOX 194
Mailing Address - City:BENTLEYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15314-1104
Mailing Address - Country:US
Mailing Address - Phone:724-239-2225
Mailing Address - Fax:724-239-2250
Practice Address - Street 1:104 JOHNSTON RD
Practice Address - Street 2:
Practice Address - City:BENTLEYVILLE
Practice Address - State:PA
Practice Address - Zip Code:15314-1104
Practice Address - Country:US
Practice Address - Phone:724-239-2225
Practice Address - Fax:724-239-2250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA005528L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA172169OtherBLUE CROSS BLUE SHIELD
PA01519701Medicaid
PA508632Medicare PIN
PA01519701Medicaid