Provider Demographics
NPI:1740280700
Name:JACKSON STROBEL, ELLEN S (DC)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:S
Last Name:JACKSON STROBEL
Suffix:
Gender:F
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:PO BOX 914
Mailing Address - Street 2:7870 WEST RIDGE RD, STE 3
Mailing Address - City:FAIRVIEW
Mailing Address - State:PA
Mailing Address - Zip Code:16415-0914
Mailing Address - Country:US
Mailing Address - Phone:814-474-3446
Mailing Address - Fax:814-474-2535
Practice Address - Street 1:7870 W RIDGE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:FAIRVIEW
Practice Address - State:PA
Practice Address - Zip Code:16415-1808
Practice Address - Country:US
Practice Address - Phone:814-474-3446
Practice Address - Fax:814-474-2535
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007701L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013447766OtherHIGHMARK BLUE CROSS BLUE
U81547Medicare UPIN
PA040552S8FMedicare PIN