Provider Demographics
NPI:1790825784
Name:EYERLY, TRICIA MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:MICHAEL
Last Name:EYERLY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 492
Mailing Address - Street 2:
Mailing Address - City:CONYNGHAM
Mailing Address - State:PA
Mailing Address - Zip Code:18219-0492
Mailing Address - Country:US
Mailing Address - Phone:570-788-3981
Mailing Address - Fax:570-788-6499
Practice Address - Street 1:BROOKHILL CENTER RT 93
Practice Address - Street 2:SUITE 1
Practice Address - City:CONYNGHAM
Practice Address - State:PA
Practice Address - Zip Code:18219
Practice Address - Country:US
Practice Address - Phone:570-788-3981
Practice Address - Fax:570-788-6499
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 007060-L111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
901332Medicare ID - Type Unspecified
PAU67178Medicare UPIN