39D0662965 CLIA NUMBER - PORT ALLEGANY FAMILY PRACTICE

Laboratory Demographics

CLIA Number: 39D0662965

Facility Name: PORT ALLEGANY FAMILY PRACTICE

Facility Address:
1 WILLOW STREET
PORT ALLEGANY, PA
ZIP 16743
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Facility Phone Number: 814 642-9531

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1972195832

Taxonomy: 111N00000X - Chiropractor
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.

CLIA Record

Field Name	Field Value
CLIA Number	39D0662965
LAB Type	Physician Office
Facility Name	PORT ALLEGANY FAMILY PRACTICE
Street	1 WILLOW STREET
City	PORT ALLEGANY
State	PA
ZIP	16743
Phone	814 642-9531
CertificateType	4
CertificateEffectiveDate	11/4/2022
CertificateExpirationDate	11/3/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024