Provider Demographics
NPI:1053613364
Name:ALLEGHENY VALLEY CHIROPRACTIC ASSOCIATES
Entity type:Organization
Organization Name:ALLEGHENY VALLEY CHIROPRACTIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:DISANTI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:724-337-1700
Mailing Address - Street 1:3008 LEECHBURG RD
Mailing Address - Street 2:
Mailing Address - City:LOWER BURRELL
Mailing Address - State:PA
Mailing Address - Zip Code:15068-3446
Mailing Address - Country:US
Mailing Address - Phone:724-337-1700
Mailing Address - Fax:724-337-1600
Practice Address - Street 1:3008 LEECHBURG RD
Practice Address - Street 2:
Practice Address - City:LOWER BURRELL
Practice Address - State:PA
Practice Address - Zip Code:15068-3446
Practice Address - Country:US
Practice Address - Phone:724-337-1700
Practice Address - Fax:724-337-1600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 001778L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1501577OtherMEDICARE ID
PA032664Medicaid