Provider Demographics
NPI:1720327018
Name:DRIVERE CHIROPRACTIC & WELLNESS P.C.
Entity Type:Organization
Organization Name:DRIVERE CHIROPRACTIC & WELLNESS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DRIVERE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-946-9410
Mailing Address - Street 1:212 W VINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW WILMINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:16142-1206
Mailing Address - Country:US
Mailing Address - Phone:724-946-9410
Mailing Address - Fax:724-946-9411
Practice Address - Street 1:212 W VINE ST
Practice Address - Street 2:
Practice Address - City:NEW WILMINGTON
Practice Address - State:PA
Practice Address - Zip Code:16142-1206
Practice Address - Country:US
Practice Address - Phone:724-946-9410
Practice Address - Fax:724-946-9411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-06
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009266111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001638338OtherHIGHMARK BC/BS
PA6882206OtherCIGNA
PA1017114200001Medicaid
PA695320OtherOPTUM
PA421641217OtherHEALTH AMERICA/HEALTH ASSURANCE
PA7432637OtherAETNA
PA210569918001OtherMEDICAL MUTUAL OF OHIO
PA720816OtherUPMC
PA1557167OtherGATEWAY
PA1557167OtherGATEWAY
PA720816OtherUPMC