Provider Demographics
NPI:1952723694
Name:LAWRENCE COUNTY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:LAWRENCE COUNTY CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GERAMITA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:724-654-2008
Mailing Address - Street 1:2024 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-5354
Mailing Address - Country:US
Mailing Address - Phone:724-654-2008
Mailing Address - Fax:724-652-5661
Practice Address - Street 1:2024 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-5354
Practice Address - Country:US
Practice Address - Phone:724-654-2008
Practice Address - Fax:724-652-5661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007191L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017363100001Medicaid
PAU73598Medicare UPIN
PA023177Medicare PIN