Provider Demographics
NPI:1063716744
Name:KS CHIROPRACTIC, PC
Entity type:Organization
Organization Name:KS CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:SUPIK
Authorized Official - Last Name:RESICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-448-2281
Mailing Address - Street 1:2876 MEADOW ST
Mailing Address - Street 2:
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-1818
Mailing Address - Country:US
Mailing Address - Phone:724-448-2281
Mailing Address - Fax:724-230-0259
Practice Address - Street 1:909 DALLAS AVE
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-2124
Practice Address - Country:US
Practice Address - Phone:724-230-0255
Practice Address - Fax:724-230-0259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009729111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty