Provider Demographics
NPI:1679566004
Name:ASSOCIATES CHIROPRACTIC CLINIC & REHABILITATION CENTER, INC.
Entity type:Organization
Organization Name:ASSOCIATES CHIROPRACTIC CLINIC & REHABILITATION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:T
Authorized Official - Last Name:HIERONIMUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:412-279-4522
Mailing Address - Street 1:2275 SWALLOW HILL RD
Mailing Address - Street 2:BUILDING 2600
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-1656
Mailing Address - Country:US
Mailing Address - Phone:412-279-4522
Mailing Address - Fax:412-279-3416
Practice Address - Street 1:2275 SWALLOW HILL RD
Practice Address - Street 2:BUILDING 2600
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-1656
Practice Address - Country:US
Practice Address - Phone:412-279-4522
Practice Address - Fax:412-279-3416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2007-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1404943OtherBS GROUP #
PA032360OtherMEDICARE GROUP NUMBER