Provider Demographics
NPI:1831317023
Name:ESSENTIAL CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ESSENTIAL CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-480-8180
Mailing Address - Street 1:429 STATE ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1135
Mailing Address - Country:US
Mailing Address - Phone:814-480-8180
Mailing Address - Fax:814-480-8182
Practice Address - Street 1:429 STATE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-1135
Practice Address - Country:US
Practice Address - Phone:814-480-8180
Practice Address - Fax:814-480-8182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009258111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012957910002Medicaid
PAU93330Medicare UPIN
PA087535Medicare ID - Type Unspecified