Provider Demographics
NPI:1629109608
Name:HILDEBRAND CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:HILDEBRAND CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HILDEBRAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-238-8540
Mailing Address - Street 1:1460 MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-3065
Mailing Address - Country:US
Mailing Address - Phone:814-238-8540
Mailing Address - Fax:814-238-8638
Practice Address - Street 1:1460 MARTIN ST
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-3065
Practice Address - Country:US
Practice Address - Phone:814-238-8540
Practice Address - Fax:814-238-8638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009752111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO48463Medicare ID - Type Unspecified