Provider Demographics
NPI:1619436250
Name:CHIROPRACTIC AND FUNCTIONAL NEUROLOGY OF WESTERN PENNSYLVANIA
Entity Type:Organization
Organization Name:CHIROPRACTIC AND FUNCTIONAL NEUROLOGY OF WESTERN PENNSYLVANIA
Other - Org Name:CORTEX CHIROPRACTIC & CLINICAL NEUROSCIENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:FARABAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MS, DACNB, FACFN
Authorized Official - Phone:814-254-4663
Mailing Address - Street 1:1722 SHELBURNE PL
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-1704
Mailing Address - Country:US
Mailing Address - Phone:814-254-4663
Mailing Address - Fax:814-254-4750
Practice Address - Street 1:360 GOUCHER ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-3400
Practice Address - Country:US
Practice Address - Phone:814-254-4663
Practice Address - Fax:814-254-4750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-13
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty