Provider Demographics
NPI:1184718066
Name:DEFFIBAUGH CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:DEFFIBAUGH CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT,/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:IRVIN
Authorized Official - Last Name:DEFFIBAUGH
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:814-276-3212
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:OSTERBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16667-0487
Mailing Address - Country:US
Mailing Address - Phone:814-276-3212
Mailing Address - Fax:814-276-9254
Practice Address - Street 1:126 OSTER STREET
Practice Address - Street 2:
Practice Address - City:OSTERBURG
Practice Address - State:PA
Practice Address - Zip Code:16667
Practice Address - Country:US
Practice Address - Phone:814-276-3212
Practice Address - Fax:814-276-9253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003223L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010623490003Medicaid
PA613565Medicare ID - Type Unspecified
PA0010623490003Medicaid