Provider Demographics
NPI:1285798710
Name:SUMMIT CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:SUMMIT CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:PASSARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-237-2225
Mailing Address - Street 1:901 BENNER PIKE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-7317
Mailing Address - Country:US
Mailing Address - Phone:814-237-2225
Mailing Address - Fax:814-237-2520
Practice Address - Street 1:901 BENNER PIKE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7317
Practice Address - Country:US
Practice Address - Phone:814-237-2225
Practice Address - Fax:814-237-2520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006316720001Medicaid
PA0009328720002Medicaid
PA01360451OtherHIGHMARK
PA02463800OtherCAPITAL BLUE CROSS
PA047281Medicare ID - Type Unspecified
PA0006316720001Medicaid
PA02463800OtherCAPITAL BLUE CROSS