Provider Demographics
NPI:1639562002
Name:HASBROUCK CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:HASBROUCK CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:HASBROUCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-664-7041
Mailing Address - Street 1:361 WORTH ST
Mailing Address - Street 2:
Mailing Address - City:CORRY
Mailing Address - State:PA
Mailing Address - Zip Code:16407-1410
Mailing Address - Country:US
Mailing Address - Phone:814-664-7041
Mailing Address - Fax:814-664-7042
Practice Address - Street 1:361 WORTH ST
Practice Address - Street 2:
Practice Address - City:CORRY
Practice Address - State:PA
Practice Address - Zip Code:16407-1410
Practice Address - Country:US
Practice Address - Phone:814-664-7041
Practice Address - Fax:814-664-7042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010679111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty