Provider Demographics
NPI:1366562753
Name:CHIROPRACTIC ASSOCIATES OF ERIE, PC
Entity type:Organization
Organization Name:CHIROPRACTIC ASSOCIATES OF ERIE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:ZIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-825-2196
Mailing Address - Street 1:4318 DEXTER AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16504-2444
Mailing Address - Country:US
Mailing Address - Phone:814-825-2196
Mailing Address - Fax:814-825-2987
Practice Address - Street 1:4318 DEXTER AVE
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504-2444
Practice Address - Country:US
Practice Address - Phone:814-825-2196
Practice Address - Fax:814-825-2987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006853L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016435980003Medicaid
PA326599OtherUPMC
804591OtherHIGHMARK BLUE SHIELD
PA343846OtherHEALTH AMERICA
PA326599OtherUPMC
PA807296Medicare PIN