Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 111N00000X | Chiropractor | | DC007635L | PENNSYLVANIA | No |
| 2 | 111N00000X | Chiropractor | | AJ007635L | PENNSYLVANIA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 0464475000 | OTHER | | IBC KEYSTONE PERSONAL CHO |
| 2 | 7730225 | OTHER | | AETNA PPO |
| 3 | 058394 | MEDICARE ID-TYPE UNSPECIFIED | | |
| 4 | P2671777 | OTHER | | OXFORD HEALTH |
| 5 | 2060659000 | OTHER | | IBC KEYSTONE PERSONAL CHO |
| 6 | 2538918 | OTHER | | AETNA HMO |
| 7 | 646452 | OTHER | | HIGHMARK BLUE SHIELD |
| 8 | 039547WNG | MEDICARE ID-TYPE UNSPECIFIED | PENNSYLVANIA | |
| 9 | N68697 | OTHER | | AMERIHEALTH GROUP |
| 10 | 1368697 | OTHER | | HIGHMARK BLUE SHIELD GROU |
| 11 | 039547QNG | OTHER | | HGS ADMINISTRATORS |
| 12 | 058394 | OTHER | | HGS ADMINISTRATORS GROUP |
| 13 | U77566 | MEDICARE UPIN | | |
