Provider Demographics
NPI:1619487790
Name:PROCARE CHIROPRACTIC SERVICES, LLC
Entity Type:Organization
Organization Name:PROCARE CHIROPRACTIC SERVICES, LLC
Other - Org Name:PROCARE CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MICHALOVICZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:412-854-6900
Mailing Address - Street 1:5250 LIBRARY RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-2715
Mailing Address - Country:US
Mailing Address - Phone:412-854-6900
Mailing Address - Fax:
Practice Address - Street 1:5250 LIBRARY RD
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-2715
Practice Address - Country:US
Practice Address - Phone:412-854-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-03
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010442111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102719817Medicaid