Provider Demographics
NPI:1568661585
Name:MIDVALLEY CHIROPRACTIC CLINIC, P.C.
Entity type:Organization
Organization Name:MIDVALLEY CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:JOSPEH
Authorized Official - Last Name:SOLACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-489-2437
Mailing Address - Street 1:503 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:OLYPHANT
Mailing Address - State:PA
Mailing Address - Zip Code:18447-1323
Mailing Address - Country:US
Mailing Address - Phone:570-489-2437
Mailing Address - Fax:570-489-5156
Practice Address - Street 1:503 SUNSET DR
Practice Address - Street 2:
Practice Address - City:OLYPHANT
Practice Address - State:PA
Practice Address - Zip Code:18447-1323
Practice Address - Country:US
Practice Address - Phone:570-489-2437
Practice Address - Fax:570-489-5156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-001450-L111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA804661OtherFIRST PRIORITY HEALTH
PA804661OtherFIRST PRIORITY HEALTH LIF
PA205279KCB PAMedicaid
PA668324Medicare PIN
PAT28686Medicare UPIN