Provider Demographics
NPI:1609095215
Name:FEDORE CHIROPRACTIC
Entity Type:Organization
Organization Name:FEDORE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:A
Authorized Official - Last Name:FEDORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-733-8200
Mailing Address - Street 1:127 ALEXANDER DR
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-9473
Mailing Address - Country:US
Mailing Address - Phone:724-733-8200
Mailing Address - Fax:
Practice Address - Street 1:4431 WILLIAM PENN HWY
Practice Address - Street 2:SUITE 4
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-1946
Practice Address - Country:US
Practice Address - Phone:724-733-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1738406OtherHIGHMARK