Provider Demographics
NPI:1740225325
Name:VILLAGE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:VILLAGE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARRA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:412-751-4991
Mailing Address - Street 1:2606 LINCOLN WAY
Mailing Address - Street 2:
Mailing Address - City:WHITE OAK
Mailing Address - State:PA
Mailing Address - Zip Code:15131-2831
Mailing Address - Country:US
Mailing Address - Phone:412-751-4991
Mailing Address - Fax:412-751-1484
Practice Address - Street 1:2606 LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:WHITE OAK
Practice Address - State:PA
Practice Address - Zip Code:15131-2831
Practice Address - Country:US
Practice Address - Phone:412-751-4991
Practice Address - Fax:412-751-1484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1377355OtherBLUE SHIELD
PA058392Medicare ID - Type Unspecified