Provider Demographics
NPI:1043270523
Name:ADVANCED CHIROPRACTIC OF GROVE CITY PC
Entity type:Organization
Organization Name:ADVANCED CHIROPRACTIC OF GROVE CITY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-458-5844
Mailing Address - Street 1:7 WOODLAND CENTER DR.
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-1507
Mailing Address - Country:US
Mailing Address - Phone:724-458-5844
Mailing Address - Fax:724-458-5899
Practice Address - Street 1:7 WOODLAND CENTER DR.
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-1507
Practice Address - Country:US
Practice Address - Phone:724-458-5844
Practice Address - Fax:724-458-5899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008881111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
070954UXMMedicare ID - Type Unspecified
U95800Medicare UPIN