Provider Demographics
NPI:1366944456
Name:CONVENIENT CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:CONVENIENT CHIROPRACTIC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-515-5599
Mailing Address - Street 1:2021 CLAY PIKE
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-6319
Mailing Address - Country:US
Mailing Address - Phone:724-515-5599
Mailing Address - Fax:724-592-5154
Practice Address - Street 1:2021 CLAY PIKE
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-6319
Practice Address - Country:US
Practice Address - Phone:724-515-5599
Practice Address - Fax:724-592-5154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011272111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty