Provider Demographics
NPI:1861677320
Name:REARDON CHIROPRACTIC
Entity Type:Organization
Organization Name:REARDON CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:EVANS
Authorized Official - Last Name:REARDON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-931-0035
Mailing Address - Street 1:317 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:MERCER
Mailing Address - State:PA
Mailing Address - Zip Code:16137-1314
Mailing Address - Country:US
Mailing Address - Phone:724-931-0035
Mailing Address - Fax:
Practice Address - Street 1:701 N HERMITAGE RD
Practice Address - Street 2:SUITE 25
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-3234
Practice Address - Country:US
Practice Address - Phone:724-931-0035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009840111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty