Provider Demographics
NPI:1578744363
Name:COLELLA CHIROPRACTIC
Entity Type:Organization
Organization Name:COLELLA CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-883-2220
Mailing Address - Street 1:200 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18643-2822
Mailing Address - Country:US
Mailing Address - Phone:570-883-2220
Mailing Address - Fax:570-883-1922
Practice Address - Street 1:200 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:WEST PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18643-2822
Practice Address - Country:US
Practice Address - Phone:570-883-2220
Practice Address - Fax:570-883-1922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004645L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA674604Medicare PIN