Provider Demographics
NPI:1619352473
Name:SOUTHWESTERN CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:SOUTHWESTERN CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:DECARLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:412-233-3600
Mailing Address - Street 1:801 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-2245
Mailing Address - Country:US
Mailing Address - Phone:412-233-3600
Mailing Address - Fax:412-233-3702
Practice Address - Street 1:801 N STATE ST
Practice Address - Street 2:
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-2245
Practice Address - Country:US
Practice Address - Phone:412-233-3600
Practice Address - Fax:412-233-3702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007246L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty