Provider Demographics
NPI:1548531734
Name:TRIFECTA CHIROPRACTIC AND WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:TRIFECTA CHIROPRACTIC AND WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC/SINGLE MEMBE
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:FETTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-832-6700
Mailing Address - Street 1:820 S MAIN ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-4139
Mailing Address - Country:US
Mailing Address - Phone:724-832-6700
Mailing Address - Fax:724-832-6711
Practice Address - Street 1:820 S MAIN ST STE 1B
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-4139
Practice Address - Country:US
Practice Address - Phone:724-832-6700
Practice Address - Fax:724-832-6711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010456111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty