Provider Demographics
NPI:1831286087
Name:CHARLEROI CHIROPRACTIC PAIN & WELLNESS CENTER INC.
Entity Type:Organization
Organization Name:CHARLEROI CHIROPRACTIC PAIN & WELLNESS CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:GILLOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-483-4834
Mailing Address - Street 1:PO BOX 16
Mailing Address - Street 2:
Mailing Address - City:CHARLEROI
Mailing Address - State:PA
Mailing Address - Zip Code:15022-0016
Mailing Address - Country:US
Mailing Address - Phone:724-483-4834
Mailing Address - Fax:724-483-0318
Practice Address - Street 1:613 FALLOWFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHARLEROI
Practice Address - State:PA
Practice Address - Zip Code:15022-1981
Practice Address - Country:US
Practice Address - Phone:724-483-4834
Practice Address - Fax:724-483-0318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005731L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA067351Medicare ID - Type UnspecifiedCHIROPRACTIC CLINIC