Provider Demographics
NPI:1730106345
Name:PENN CENTER CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:PENN CENTER CHIROPRACTIC CLINIC PC
Other - Org Name:DR BERTOLINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BERTOLINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-823-2180
Mailing Address - Street 1:3424 WM PENN HWY
Mailing Address - Street 2:SUITE 168
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235
Mailing Address - Country:US
Mailing Address - Phone:412-823-2180
Mailing Address - Fax:412-823-6165
Practice Address - Street 1:3424 WM PENN HWY
Practice Address - Street 2:SUITE 168
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235
Practice Address - Country:US
Practice Address - Phone:412-823-2180
Practice Address - Fax:412-823-6165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006365L111N00000X
PAAJ006365L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
201965OtherUPMC
9482084OtherCIGNA
1796384OtherHIGHMARK
9482084OtherCIGNA
098723Medicare ID - Type Unspecified