Provider Demographics
NPI:1942552823
Name:PENN CENTER CHIROPRACTIC & REHAB PC
Entity Type:Organization
Organization Name:PENN CENTER CHIROPRACTIC & REHAB PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:BENZ
Authorized Official - Last Name:SUCCOP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:412-823-2180
Mailing Address - Street 1:3424 WILLIAM PENN HWY
Mailing Address - Street 2:SUITE 168
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-5444
Mailing Address - Country:US
Mailing Address - Phone:412-823-2180
Mailing Address - Fax:412-823-6165
Practice Address - Street 1:3424 WILLIAM PENN HWY
Practice Address - Street 2:SUITE 168
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-5444
Practice Address - Country:US
Practice Address - Phone:412-823-2180
Practice Address - Fax:412-823-6165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009354111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001669989OtherHIGHMARK BC/BS
PA722970OtherUPMC
PA0867647GGMedicare UPIN