Provider Demographics
NPI:1851461271
Name:LAWRENCE COUNTY CHIROPRACTIC
Entity Type:Organization
Organization Name:LAWRENCE COUNTY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GERAMITA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:724-654-2008
Mailing Address - Street 1:1700 NEW BUTLER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-3152
Mailing Address - Country:US
Mailing Address - Phone:724-654-2008
Mailing Address - Fax:724-652-5661
Practice Address - Street 1:1700 NEW BUTLER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-3152
Practice Address - Country:US
Practice Address - Phone:724-654-2008
Practice Address - Fax:724-652-5661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-007191-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000000088944OtherUNISON HEALTH PLAN
PA1506091OtherGATEWAY HEALTH PLAN
PA5542731OtherAETNA
PA0017363100001Medicaid
PWGE990499OtherHIGHMARK
PA2096404OtherAETNA
PA309975OtherUPMC
PAGE996048OtherHIGHMARK
OH=========-01OtherOHIO BUREAU OF WORKERS CO
OH=========-01OtherOHIO BUREAU OF WORKERS CO
PA023177Medicare ID - Type Unspecified