Provider Demographics
NPI:1720070105
Name:MISCOE II, FREDERIC J, (DC)
Entity Type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:J,
Last Name:MISCOE II
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-1614
Mailing Address - Country:US
Mailing Address - Phone:814-266-3314
Mailing Address - Fax:814-262-0800
Practice Address - Street 1:215 BELMONT ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-1614
Practice Address - Country:US
Practice Address - Phone:814-266-3314
Practice Address - Fax:814-262-0800
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 2890-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010353320001Medicaid
PA172388Medicare ID - Type Unspecified
PA0010353320001Medicaid