Provider Demographics
NPI:1912909656
Name:CHADWICK, KIRK WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:KIRK
Middle Name:WILLIAM
Last Name:CHADWICK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-1113
Mailing Address - Country:US
Mailing Address - Phone:814-226-4033
Mailing Address - Fax:814-226-4034
Practice Address - Street 1:514 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-1113
Practice Address - Country:US
Practice Address - Phone:814-226-4033
Practice Address - Fax:814-226-4034
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001618L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006201780002Medicaid
PAT29958Medicare UPIN
PA179642Medicare ID - Type Unspecified