Provider Demographics
NPI:1598709370
Name:DR. R.J. SCANLAN CHIROPRACTIC CLINIC, P,C.
Entity Type:Organization
Organization Name:DR. R.J. SCANLAN CHIROPRACTIC CLINIC, P,C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:V
Authorized Official - Last Name:SCANLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-472-8130
Mailing Address - Street 1:1000 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-1169
Mailing Address - Country:US
Mailing Address - Phone:814-472-8130
Mailing Address - Fax:814-472-4928
Practice Address - Street 1:1000 N CENTER ST
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-1169
Practice Address - Country:US
Practice Address - Phone:814-472-8130
Practice Address - Fax:814-472-4928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003049L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT28943Medicare UPIN