1740373943 NPI number — LIFEFORCE CHIROPRACTIC INCORPORATED

Table of content: (NPI 1740373943)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740373943 NPI number — LIFEFORCE CHIROPRACTIC INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFEFORCE CHIROPRACTIC INCORPORATED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740373943
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5400 KEEPORT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15236-3006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-655-8171
Provider Business Mailing Address Fax Number:
412-655-7232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5400 KEEPORT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15236-3006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-655-8171
Provider Business Practice Location Address Fax Number:
412-655-7232
Provider Enumeration Date:
10/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RUSCITTO
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
GUY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
412-655-8171

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 091346 . This is a "KEYSTONE HEALTH PLAN WEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 419412 . This is a "HEALTH AMERICA/ASSURANCE" identifier . This identifiers is of the category "OTHER".