Provider Demographics
NPI:1457571820
Name:BERETTA CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:BERETTA CHIROPRACTIC, INC.
Other - Org Name:BERETTA CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BERETTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-744-0300
Mailing Address - Street 1:3506 ROUTE 130
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642
Mailing Address - Country:US
Mailing Address - Phone:724-744-0300
Mailing Address - Fax:724-744-0303
Practice Address - Street 1:3506 ROUTE 130
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-1699
Practice Address - Country:US
Practice Address - Phone:724-744-0300
Practice Address - Fax:724-744-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005970L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1645057OtherHIGHMARK NUMBER
PA1645057OtherHIGHMARK NUMBER
PAV51466Medicare UPIN