Provider Demographics
NPI:1992127799
Name:PATHWAYS CHIROPRACTIC CENTER PA
Entity type:Organization
Organization Name:PATHWAYS CHIROPRACTIC CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BURKE
Authorized Official - Middle Name:RAFER
Authorized Official - Last Name:MAYS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-634-5892
Mailing Address - Street 1:4825 OLSON MEMORIAL HWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-5147
Mailing Address - Country:US
Mailing Address - Phone:763-634-5892
Mailing Address - Fax:
Practice Address - Street 1:4825 OLSON MEMORIAL HWY
Practice Address - Street 2:SUITE 150
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-5147
Practice Address - Country:US
Practice Address - Phone:763-634-5892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN003502261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service