Provider Demographics
NPI:1174809719
Name:CLEONA CHIROPRACTIC
Entity type:Organization
Organization Name:CLEONA CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:FINK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-273-7300
Mailing Address - Street 1:14 E PENN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEONA
Mailing Address - State:PA
Mailing Address - Zip Code:17042-3221
Mailing Address - Country:US
Mailing Address - Phone:717-273-7300
Mailing Address - Fax:717-273-4779
Practice Address - Street 1:14 E PENN AVE
Practice Address - Street 2:
Practice Address - City:CLEONA
Practice Address - State:PA
Practice Address - Zip Code:17042-3221
Practice Address - Country:US
Practice Address - Phone:717-273-7300
Practice Address - Fax:717-273-4779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008959111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA072641Medicare PIN