Provider Demographics
NPI:1487767943
Name:TOTAL BODY CHIROPRACTIC PC
Entity type:Organization
Organization Name:TOTAL BODY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KRAH
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:510-562-7770
Mailing Address - Street 1:125 N. MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:PA
Mailing Address - Zip Code:18517
Mailing Address - Country:US
Mailing Address - Phone:570-562-7770
Mailing Address - Fax:570-562-7775
Practice Address - Street 1:125 N. MAIN ST
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:PA
Practice Address - Zip Code:18517
Practice Address - Country:US
Practice Address - Phone:570-562-7770
Practice Address - Fax:570-562-7775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007472L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T0471900OtherBLUE SHIELD
PA0017749000004Medicaid
T0471900OtherBLUE SHIELD
PA028204NCYMedicare PIN
PA028204NCYMedicare UPIN