Provider Demographics
NPI:1821039520
Name:NEW CASTLE CHIROPRACTIC CENTER, PA
Entity Type:Organization
Organization Name:NEW CASTLE CHIROPRACTIC CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-322-6676
Mailing Address - Street 1:702 E BASIN RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-4203
Mailing Address - Country:US
Mailing Address - Phone:302-322-6676
Mailing Address - Fax:302-328-5717
Practice Address - Street 1:702 E BASIN RD
Practice Address - Street 2:SUITE 2
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-4203
Practice Address - Country:US
Practice Address - Phone:302-322-6676
Practice Address - Fax:302-328-5717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF10000368111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE50938Medicare UPIN
DE143867Medicare ID - Type Unspecified