Provider Demographics
NPI:1851675243
Name:NUTRITION AND HEALING CENTER, INC.
Entity Type:Organization
Organization Name:NUTRITION AND HEALING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TASMIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CORDIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-866-3366
Mailing Address - Street 1:1455 WEST 38TH STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508
Mailing Address - Country:US
Mailing Address - Phone:814-866-3366
Mailing Address - Fax:814-866-8877
Practice Address - Street 1:1455 WEST 38TH STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508
Practice Address - Country:US
Practice Address - Phone:814-866-3366
Practice Address - Fax:814-866-8877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA9093111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009029650001Medicaid
PA1009029650001Medicaid