Provider Demographics
NPI:1063408839
Name:HORDESKY-SEDOROVITZ, MARY ANN (DC)
Entity type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:
Last Name:HORDESKY-SEDOROVITZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MARY ANN
Other - Middle Name:MICHELE
Other - Last Name:HORDESKY-SEDOROVITZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:627 OHARA ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-3307
Mailing Address - Country:US
Mailing Address - Phone:570-780-8438
Mailing Address - Fax:570-347-1534
Practice Address - Street 1:10 GREEN RIDGE ST STE 2
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509-1828
Practice Address - Country:US
Practice Address - Phone:570-780-8438
Practice Address - Fax:570-347-1534
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006921L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
7416479OtherAETNA HEALTH INS
PA001549229OtherHIGHMARK BLUESHIELD
7416479OtherAETNA HEALTH INS
U92770Medicare UPIN