Basic Information
| Provider Information | |||||||||
| NPI: | 1972033587 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SCALISE CHIROPRACTIC PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12280 STATE ROUTE 30 | ||||||||
| Address2: | |||||||||
| City: | NORTH HUNTINGDON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156421820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248647447 | ||||||||
| FaxNumber: | 7248648022 | ||||||||
| Practice Location | |||||||||
| Address1: | 12280 STATE ROUTE 30 | ||||||||
| Address2: | |||||||||
| City: | NORTH HUNTINGDON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248647447 | ||||||||
| FaxNumber: | 7248648022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | SCALISE | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7248647447 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | DC-5162 | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 25-1799260 | 01 | PA | TAX ID | OTHER | 0017498000002 | 05 | PA | MEDICAID |