Provider Demographics
NPI:1730701962
Name:IADELUCA CHIROPRACTIC CENTER MEADVILLE PC
Entity type:Organization
Organization Name:IADELUCA CHIROPRACTIC CENTER MEADVILLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:IADELUCA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-459-2580
Mailing Address - Street 1:2921 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-2501
Mailing Address - Country:US
Mailing Address - Phone:814-459-2580
Mailing Address - Fax:814-459-2584
Practice Address - Street 1:11581 PENNSYLVANIA AVE # 98
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-6247
Practice Address - Country:US
Practice Address - Phone:814-336-3434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IADELUCA CHIROPRACTIC CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-11
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1699989921OtherNPI