Provider Demographics
NPI:1295810687
Name:NITTANY VALLEY CHIROPRACTIC CENTER, LLC
Entity type:Organization
Organization Name:NITTANY VALLEY CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:CORNISH
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-234-5271
Mailing Address - Street 1:611 UNIVERSITY DR
Mailing Address - Street 2:214
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-6552
Mailing Address - Country:US
Mailing Address - Phone:814-234-5271
Mailing Address - Fax:814-234-9730
Practice Address - Street 1:611 UNIVERSITY DR
Practice Address - Street 2:214
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-6552
Practice Address - Country:US
Practice Address - Phone:814-234-5271
Practice Address - Fax:814-234-9730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC03147111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA087053Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER