Provider Demographics
NPI:1609889237
Name:HARCHAK CHIROPRACTIC CLINIC LLC
Entity Type:Organization
Organization Name:HARCHAK CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:I
Authorized Official - Last Name:HARCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-342-3591
Mailing Address - Street 1:1114 WALTON ST
Mailing Address - Street 2:
Mailing Address - City:PHILIPSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16866-2748
Mailing Address - Country:US
Mailing Address - Phone:814-342-3591
Mailing Address - Fax:814-342-5815
Practice Address - Street 1:1114 WALTON ST
Practice Address - Street 2:
Practice Address - City:PHILIPSBURG
Practice Address - State:PA
Practice Address - Zip Code:16866-2748
Practice Address - Country:US
Practice Address - Phone:814-342-3591
Practice Address - Fax:814-342-5815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003451L261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011294660001Medicaid
PA146682UX5Medicare ID - Type Unspecified
PA0011294660001Medicaid