Provider Demographics
NPI:1740753268
Name:UNIVERSITY CHIROPRACTIC AND MYOFASCIAL PAIN CENTER, LLC
Entity Type:Organization
Organization Name:UNIVERSITY CHIROPRACTIC AND MYOFASCIAL PAIN CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAGONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-330-5185
Mailing Address - Street 1:346 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:PA
Mailing Address - Zip Code:15419-1162
Mailing Address - Country:US
Mailing Address - Phone:724-330-5185
Mailing Address - Fax:724-330-5187
Practice Address - Street 1:346 3RD ST
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:PA
Practice Address - Zip Code:15419-1162
Practice Address - Country:US
Practice Address - Phone:724-330-5185
Practice Address - Fax:724-330-5187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty