Provider Demographics
NPI:1720275712
Name:ATLAS CHIROPRACTIC OF LIGONIER P.C.
Entity Type:Organization
Organization Name:ATLAS CHIROPRACTIC OF LIGONIER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:PACIENZA
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:724-238-6920
Mailing Address - Street 1:621 W MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-1017
Mailing Address - Country:US
Mailing Address - Phone:724-238-6920
Mailing Address - Fax:724-238-6940
Practice Address - Street 1:621 W MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658-1017
Practice Address - Country:US
Practice Address - Phone:724-238-6920
Practice Address - Fax:724-238-6940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009648111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1561741OtherGATEWAY HEALTH PLAN
PA1016667820001Medicaid
PA1881737OtherAMERIHEALTH
PA2749594000OtherINDEPENDENCE BLUE CROSS
PA1881737OtherHIGHMARK BCBS
PA1016667820001Medicaid
PA2749594000OtherINDEPENDENCE BLUE CROSS