Provider Demographics
NPI:1215245881
Name:SCRANTON CLINIC OF CHIROPRACTIC
Entity type:Organization
Organization Name:SCRANTON CLINIC OF CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCRANTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-230-3971
Mailing Address - Street 1:4775 W. DAYBREAK PARKWAY
Mailing Address - Street 2:ST. 102
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095
Mailing Address - Country:US
Mailing Address - Phone:309-737-1534
Mailing Address - Fax:432-204-3527
Practice Address - Street 1:4775 W. DAYBREAK PARKWAY
Practice Address - Street 2:ST. 102
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095
Practice Address - Country:US
Practice Address - Phone:309-737-1534
Practice Address - Fax:432-204-3527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8689336-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL582240Medicare PIN