Provider Demographics
NPI:1609078690
Name:PEDROW, JOHN NMN (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:NMN
Last Name:PEDROW
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14429 ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:N HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:15642-1057
Mailing Address - Country:US
Mailing Address - Phone:412-823-8090
Mailing Address - Fax:412-829-1829
Practice Address - Street 1:14429 ROUTE 30
Practice Address - Street 2:
Practice Address - City:N HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:15642-1057
Practice Address - Country:US
Practice Address - Phone:412-823-8090
Practice Address - Fax:412-829-1829
Is Sole Proprietor?:No
Enumeration Date:2007-06-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001680L111N00000X
FLCH3608111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH3608OtherLICENSE NUMBER
PA25-1400613OtherTAX ID
PADC001680LOtherLICENSE NUMBER
PA25-1400613OtherTAX ID
PA084716H3QMedicare ID - Type UnspecifiedCHIROPRACTOR