Provider Demographics
NPI:1790718468
Name:MISCOE CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:MISCOE CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:MISCOE
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:814-266-3314
Mailing Address - Street 1:215 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-1614
Mailing Address - Country:US
Mailing Address - Phone:814-266-3314
Mailing Address - Fax:814-266-8821
Practice Address - Street 1:215 BELMONT ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-1614
Practice Address - Country:US
Practice Address - Phone:814-266-3314
Practice Address - Fax:814-262-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-2890-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010353320001Medicaid
PA0010353320001Medicaid
PA172388Medicare ID - Type Unspecified