Provider Demographics
NPI:1871728428
Name:BUTLER AVE NC CHIROPRACTIC CENTER PC
Entity type:Organization
Organization Name:BUTLER AVE NC CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:EDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-657-8084
Mailing Address - Street 1:1004 BUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-4282
Mailing Address - Country:US
Mailing Address - Phone:724-657-8084
Mailing Address - Fax:724-657-8373
Practice Address - Street 1:1829 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:PA
Practice Address - Zip Code:15431-2050
Practice Address - Country:US
Practice Address - Phone:724-628-6677
Practice Address - Fax:724-628-4611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-27
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002501L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty