Provider Demographics
NPI:1972959773
Name:HOMETOWN SPINE & SPORT, LLC
Entity type:Organization
Organization Name:HOMETOWN SPINE & SPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOMKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-351-2982
Mailing Address - Street 1:7350 STEUBENVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15071-9103
Mailing Address - Country:US
Mailing Address - Phone:412-490-1700
Mailing Address - Fax:
Practice Address - Street 1:7350 STEUBENVILLE PIKE
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:PA
Practice Address - Zip Code:15071-9103
Practice Address - Country:US
Practice Address - Phone:412-490-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010803111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty