Provider Demographics
NPI:1629608179
Name:LARGE CHIROPRACTIC ASSOCIATES, LLC
Entity Type:Organization
Organization Name:LARGE CHIROPRACTIC ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/MANAGER OF THE COMPANY
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:H
Authorized Official - Last Name:LARGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-630-3712
Mailing Address - Street 1:3572 BRODHEAD RD STE 301
Mailing Address - Street 2:
Mailing Address - City:MONACA
Mailing Address - State:PA
Mailing Address - Zip Code:15061-3141
Mailing Address - Country:US
Mailing Address - Phone:878-439-7157
Mailing Address - Fax:878-439-7158
Practice Address - Street 1:3572 BRODHEAD RD STE 302
Practice Address - Street 2:
Practice Address - City:MONACA
Practice Address - State:PA
Practice Address - Zip Code:15061-3141
Practice Address - Country:US
Practice Address - Phone:878-439-7157
Practice Address - Fax:878-439-7158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-23
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1034332510002Medicaid