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 | 111NX0100X | Chiropractor | Occupational Health | DC006235L | PENNSYLVANIA | No |
| 2 | 111N00000X | Chiropractor | | DC006235L | 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 | 1007640 | OTHER | PENNSYLVANIA | ASHN |
| 2 | 2298072 | OTHER | PENNSYLVANIA | AETNA HMO ID |
| 3 | 339411 | OTHER | PENNSYLVANIA | HEALTH AMERICA |
| 4 | 350052217 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE |
| 5 | 0015407230003 | MEDICAID | PENNSYLVANIA | |
| 6 | 0814753000 | OTHER | PENNSYLVANIA | INDEPENDENCE BLUE CROSS |
| 7 | 789959 | OTHER | PENNSYLVANIA | FIRST PRIORITY LIFE INS |
| 8 | U57016 | MEDICARE UPIN | PENNSYLVANIA | |
| 9 | 789959 | MEDICARE ID-TYPE UNSPECIFIED | PENNSYLVANIA | MEDICARE PROVIDER NUMBER |
| 10 | 45223 | OTHER | PENNSYLVANIA | GEISINGER HEALTH PLAN |
| 11 | 20039719 | OTHER | PENNSYLVANIA | AMERIHEALTH MERCY |
| 12 | 2194938 | OTHER | PENNSYLVANIA | FIRST HEALTH |
| 13 | 339411 | OTHER | PENNSYLVANIA | ADVANTRA FREEDOM |
| 14 | 5622279 | OTHER | PENNSYLVANIA | AETNA PPO ID |
| 15 | 118377 | OTHER | PENNSYLVANIA | UNISON HEALTH PLAN |
| 16 | 2983739 | OTHER | PENNSYLVANIA | CIGNA HEALTHCARE |
| 17 | 825782 | OTHER | PENNSYLVANIA | FIRST PRIORITY HEALTH |
| 18 | 350052217 | OTHER | PENNSYLVANIA | RAILROAD MEDICARE NO. |
| 19 | 611305800 | OTHER | PENNSYLVANIA | US DEPT. OF LABOR |
| 20 | 789959 | OTHER | PENNSYLVANIA | HIGHMARK BC/BS |
