Provider Demographics
NPI:1972195832
Name:PORT ALLEGANY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:PORT ALLEGANY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:M
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:716-307-7904
Mailing Address - Street 1:717 E MILL ST
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEGANY
Mailing Address - State:PA
Mailing Address - Zip Code:16743-9743
Mailing Address - Country:US
Mailing Address - Phone:814-642-7236
Mailing Address - Fax:814-313-7535
Practice Address - Street 1:717 E MILL ST
Practice Address - Street 2:
Practice Address - City:PORT ALLEGANY
Practice Address - State:PA
Practice Address - Zip Code:16743-9743
Practice Address - Country:US
Practice Address - Phone:814-642-7236
Practice Address - Fax:814-313-7535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty