Provider Demographics
NPI:1932274586
Name:TIGUE CHIROPRACTIC INC
Entity Type:Organization
Organization Name:TIGUE CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNNITA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TIGUE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-226-6299
Mailing Address - Street 1:662 ROUTE 739 STE 2
Mailing Address - Street 2:
Mailing Address - City:LORDS VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18428-6085
Mailing Address - Country:US
Mailing Address - Phone:570-775-6205
Mailing Address - Fax:570-775-6205
Practice Address - Street 1:662 ROUTE 739 STE 2
Practice Address - Street 2:
Practice Address - City:LORDS VALLEY
Practice Address - State:PA
Practice Address - Zip Code:18428-6085
Practice Address - Country:US
Practice Address - Phone:570-775-6205
Practice Address - Fax:570-775-6205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008740111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001640258OtherBLUE SHIELD
PA818418OtherFIRST PRIORITY
PA1012312930001Medicaid
PA085121Medicare ID - Type Unspecified
PA1012312930001Medicaid