Provider Demographics
NPI:1356535504
Name:FOUNTAIN MILLS CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:FOUNTAIN MILLS CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JON
Authorized Official - Last Name:PAGLIACCI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-887-7269
Mailing Address - Street 1:17 N CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15683-1714
Mailing Address - Country:US
Mailing Address - Phone:724-887-7269
Mailing Address - Fax:
Practice Address - Street 1:17 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SCOTTDALE
Practice Address - State:PA
Practice Address - Zip Code:15683-1714
Practice Address - Country:US
Practice Address - Phone:724-887-7269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009392111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty