Provider Demographics
NPI:1780798132
Name:PROADJUSTER CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:PROADJUSTER CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LASTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-942-4444
Mailing Address - Street 1:3380 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MCMURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-3065
Mailing Address - Country:US
Mailing Address - Phone:724-942-4444
Mailing Address - Fax:724-731-0151
Practice Address - Street 1:3380 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MCMURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-3065
Practice Address - Country:US
Practice Address - Phone:724-942-4444
Practice Address - Fax:724-731-0151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA11N00000X111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAV07626Medicare UPIN
PAU24937Medicare UPIN
PA096589Medicare ID - Type UnspecifiedDR MARYANN LUXEDER
PA561207Medicare ID - Type UnspecifiedDR KEVIN LASTER