Provider Demographics
NPI:1487364006
Name:TWISTED ROOTS CHIROPRACTIC PC
Entity type:Organization
Organization Name:TWISTED ROOTS CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SACCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-233-4837
Mailing Address - Street 1:110 N MOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-1119
Mailing Address - Country:US
Mailing Address - Phone:570-261-7792
Mailing Address - Fax:570-261-4544
Practice Address - Street 1:110 N MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN TOP
Practice Address - State:PA
Practice Address - Zip Code:18707-1119
Practice Address - Country:US
Practice Address - Phone:570-261-7792
Practice Address - Fax:570-261-4544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty