Provider Demographics
NPI:1548519440
Name:LATRONICA SPORTS AND FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:LATRONICA SPORTS AND FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LATRONICA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:267-454-7158
Mailing Address - Street 1:740 EDISON FURLONG ROAD
Mailing Address - Street 2:
Mailing Address - City:FURLONG
Mailing Address - State:PA
Mailing Address - Zip Code:18925
Mailing Address - Country:US
Mailing Address - Phone:267-454-7158
Mailing Address - Fax:267-454-7160
Practice Address - Street 1:740 EDISON FURLONG ROAD
Practice Address - Street 2:
Practice Address - City:FURLONG
Practice Address - State:PA
Practice Address - Zip Code:18925
Practice Address - Country:US
Practice Address - Phone:267-454-7158
Practice Address - Fax:267-454-7160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-003146-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PALA/137213Medicare UPIN