Provider Demographics
NPI:1750680708
Name:CASTEEL CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:CASTEEL CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:B
Authorized Official - Last Name:CASTEEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-342-4711
Mailing Address - Street 1:P.O. BOX 248
Mailing Address - Street 2:
Mailing Address - City:PHILIPSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16866-2128
Mailing Address - Country:US
Mailing Address - Phone:814-342-4711
Mailing Address - Fax:814-342-1689
Practice Address - Street 1:210 E. LOCUST STREET
Practice Address - Street 2:
Practice Address - City:PHILIPSBURG
Practice Address - State:PA
Practice Address - Zip Code:16866-2128
Practice Address - Country:US
Practice Address - Phone:814-342-4711
Practice Address - Fax:814-342-1689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002783L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009658640001Medicaid
PA0009658640001Medicaid