Provider Demographics
NPI:1689842635
Name:DANIEL A DZIAK PC
Entity Type:Organization
Organization Name:DANIEL A DZIAK PC
Other - Org Name:BANKSVILLE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:DZIAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:412-344-5500
Mailing Address - Street 1:3102 BANKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15216-2721
Mailing Address - Country:US
Mailing Address - Phone:412-344-5500
Mailing Address - Fax:412-344-5500
Practice Address - Street 1:3102 BANKSVILLE RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15216-2721
Practice Address - Country:US
Practice Address - Phone:412-344-5500
Practice Address - Fax:412-344-5500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007094-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001350834OtherKEYSTONE
PA012566OtherMEDICARE
PA0018813660001Medicaid
PAU71323Medicare UPIN