Provider Demographics
NPI:1386789121
Name:MILLCREEK CHIROPRACTIC ASSOCIATES P.C.
Entity type:Organization
Organization Name:MILLCREEK CHIROPRACTIC ASSOCIATES P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:COBERT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:814-835-5039
Mailing Address - Street 1:4108 ZUCK RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-4539
Mailing Address - Country:US
Mailing Address - Phone:814-835-5039
Mailing Address - Fax:814-835-7723
Practice Address - Street 1:4108 ZUCK RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-4539
Practice Address - Country:US
Practice Address - Phone:814-835-5039
Practice Address - Fax:814-835-7723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-006458-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA446052OtherPROVIDER ID
PAU64052Medicare UPIN