Provider Demographics
NPI:1386962025
Name:CENTRE CHIROPRACTIC PC
Entity type:Organization
Organization Name:CENTRE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:HERTERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-466-2000
Mailing Address - Street 1:128 BOAL AVE
Mailing Address - Street 2:P.O. BOX 680
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827-1442
Mailing Address - Country:US
Mailing Address - Phone:814-466-2000
Mailing Address - Fax:814-466-2228
Practice Address - Street 1:128 BOAL AVE
Practice Address - Street 2:
Practice Address - City:BOALSBURG
Practice Address - State:PA
Practice Address - Zip Code:16827-1442
Practice Address - Country:US
Practice Address - Phone:814-466-2000
Practice Address - Fax:814-466-2228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009586111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty