Provider Demographics
NPI:1306050950
Name:CHIROPRACTIC & REHAB ASSOCIATES, P.C.
Entity type:Organization
Organization Name:CHIROPRACTIC & REHAB ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERBENER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-836-5305
Mailing Address - Street 1:112 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657-1799
Mailing Address - Country:US
Mailing Address - Phone:570-836-5305
Mailing Address - Fax:570-836-6564
Practice Address - Street 1:112 RIVER ST
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-1799
Practice Address - Country:US
Practice Address - Phone:570-836-5305
Practice Address - Fax:570-836-6564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007819L111NR0400X
PADC006129L111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015583990002Medicaid
PA814278OtherFIRST PRIORITY
PA611633OtherBLUE CROSS BLUE SHIELD
PW540709OtherAETNA
PAU056243Medicare UPIN
PA814278OtherFIRST PRIORITY