Provider Demographics
NPI:1215393509
Name:WARNINGER CHIROPRACTIC AND NORTHEASTERN PHYSICAL THERAPY
Entity type:Organization
Organization Name:WARNINGER CHIROPRACTIC AND NORTHEASTERN PHYSICAL THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHON
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:WARNINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-644-8120
Mailing Address - Street 1:1619 N 9TH ST STE 9
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-6501
Mailing Address - Country:US
Mailing Address - Phone:570-664-8120
Mailing Address - Fax:570-664-8128
Practice Address - Street 1:1619 N 9TH ST STE 9
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-6501
Practice Address - Country:US
Practice Address - Phone:570-664-8120
Practice Address - Fax:570-664-8128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-03
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMSG008660OtherPA MASSAGE LICENSE
004476183OtherHIGHMARK BILLING ID
PADC011090OtherPA CHIROPRACTIC LICENSE