Provider Demographics
NPI:1306118781
Name:LOGAN VALLEY CHIROPRACTIC
Entity type:Organization
Organization Name:LOGAN VALLEY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:BUMBARGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-944-8483
Mailing Address - Street 1:3014 PLEASANT VALLEY BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4491
Mailing Address - Country:US
Mailing Address - Phone:814-944-8483
Mailing Address - Fax:814-944-5375
Practice Address - Street 1:3014 PLEASANT VALLEY BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4491
Practice Address - Country:US
Practice Address - Phone:814-944-8483
Practice Address - Fax:814-944-5375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010352111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty