Provider Demographics
NPI:1245340462
Name:NEW STANTON CHIROPRACTIC
Entity type:Organization
Organization Name:NEW STANTON CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAFER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-925-2244
Mailing Address - Street 1:163 W PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:NEW STANTON
Mailing Address - State:PA
Mailing Address - Zip Code:15672-9474
Mailing Address - Country:US
Mailing Address - Phone:724-925-2244
Mailing Address - Fax:
Practice Address - Street 1:163 W PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:NEW STANTON
Practice Address - State:PA
Practice Address - Zip Code:15672-9474
Practice Address - Country:US
Practice Address - Phone:724-925-2244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1355536OtherBLUE CROSS BLUE SHIELD
PA0015044500001Medicaid
PA409060OtherHEALTH AMERICA
PA1509124Medicaid
PA86284Medicare ID - Type UnspecifiedUNISON
PA0015044500001Medicaid
PA1355536OtherBLUE CROSS BLUE SHIELD