Provider Demographics
NPI:1609063221
Name:8TH ST FAMILY CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:8TH ST FAMILY CHIROPRACTIC CENTER
Other - Org Name:CYNTHIA M KENNELLY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KENNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-693-9393
Mailing Address - Street 1:131 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:PA
Mailing Address - Zip Code:18644-1607
Mailing Address - Country:US
Mailing Address - Phone:570-693-9393
Mailing Address - Fax:570-693-6178
Practice Address - Street 1:131 W 8TH ST
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:PA
Practice Address - Zip Code:18644-1607
Practice Address - Country:US
Practice Address - Phone:570-693-9393
Practice Address - Fax:570-693-6178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004703L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA691197OtherBLUE SHIELD
PA0014323050001Medicaid
PA805042OtherFIRST PRIORITY HEALTH
PA0014323050001Medicaid