Provider Demographics
NPI:1679804348
Name:PORZIO-HAWLEY CHIROPRACTIC & NUTRITION CENTER LLC
Entity type:Organization
Organization Name:PORZIO-HAWLEY CHIROPRACTIC & NUTRITION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PORZIO-HAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-304-0374
Mailing Address - Street 1:210 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-1008
Mailing Address - Country:US
Mailing Address - Phone:860-384-0374
Mailing Address - Fax:
Practice Address - Street 1:210 N STATE ST
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1008
Practice Address - Country:US
Practice Address - Phone:860-384-0374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001757111N00000X
CT001755111N00000X
PADC010864111N00000X
PADC010865111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty