Provider Demographics
NPI:1134248354
Name:CHURMA CHIROPRACTIC CENTER PC
Entity type:Organization
Organization Name:CHURMA CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:CHURMA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:412-373-1310
Mailing Address - Street 1:2137 MOSSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-4218
Mailing Address - Country:US
Mailing Address - Phone:412-373-1310
Mailing Address - Fax:412-372-9266
Practice Address - Street 1:2137 MOSSIDE BLVD
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-4218
Practice Address - Country:US
Practice Address - Phone:412-373-1310
Practice Address - Fax:412-372-9266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002491L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010049440001Medicaid
PAT72778Medicare UPIN
PA0010049440001Medicaid