Provider Demographics
NPI:1699989921
Name:IADELUCA CHIROPRACTIC CENTER INC
Entity type:Organization
Organization Name:IADELUCA CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO - DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:IADELUCA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-864-9775
Mailing Address - Street 1:3721 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2651
Mailing Address - Country:US
Mailing Address - Phone:814-864-9775
Mailing Address - Fax:814-864-7227
Practice Address - Street 1:3721 POPLAR ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2651
Practice Address - Country:US
Practice Address - Phone:814-864-9775
Practice Address - Fax:814-864-7227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-007310-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U78717Medicare UPIN
PA056975Medicare ID - Type UnspecifiedHGS ADMIN