Provider Demographics
NPI:1831503341
Name:FULL FUNCTION CHIROPRACTIC LLC
Entity type:Organization
Organization Name:FULL FUNCTION CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-490-2533
Mailing Address - Street 1:262 HOGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:MILL HALL
Mailing Address - State:PA
Mailing Address - Zip Code:17751-1907
Mailing Address - Country:US
Mailing Address - Phone:570-748-2500
Mailing Address - Fax:570-748-2501
Practice Address - Street 1:262 HOGAN BLVD
Practice Address - Street 2:
Practice Address - City:MILL HALL
Practice Address - State:PA
Practice Address - Zip Code:17751-1907
Practice Address - Country:US
Practice Address - Phone:570-748-2500
Practice Address - Fax:570-748-2501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010394111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty