Icarus Chiropractic LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

DC011132 Issued in PA

Legal business name

ICARUS CHIROPRACTIC LLC

Practice address

210 6TH St
Suite 7
Clymer, PA 15728-1257

Phone

(724) 422-8070

Fax

(724) 905-8084

NPI assigned

Apr 13, 2016

Last updated

Jun 15, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Johnathan Clark, DC

Title

Owner

Phone

(724) 422-8070

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1460505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465948800000",
    "number": "1225492465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 6TH ST",
            "address_2": "SUITE 7",
            "city": "CLYMER",
            "state": "PA",
            "postal_code": "157281257",
            "telephone_number": "724-422-8070",
            "fax_number": "724-905-8084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 6TH ST",
            "address_2": "SUITE 7",
            "city": "CLYMER",
            "state": "PA",
            "postal_code": "157281257",
            "telephone_number": "724-422-8070",
            "fax_number": "724-905-8084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICARUS CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-13",
        "last_updated": "2016-06-15",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "JOHNATHAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "724-422-8070",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "PA",
            "license": "DC011132",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "504984",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Crossbridge Physical Therapy
• Russell Drozdiak, M.D.
• Mary Agnes Fletcher, MS,MSPT,OCS,ATC
• Melissa Ann Gett, OTR/L
• Brandon Lee Haggerty, DPT
• Indiana Regional Medical Center (Irmc Clymer Family Medicine)
• Claire Anne Kirsch, MS, LPC, NCC
• Mahoning Physical Therapy Inc
• Mary Beth Marocline
• Mary Beth Marcoline (Scerbos Pharmacy)

• Clinic/Center in Clymer, PA
• Providers in Clymer, PA by specialty
• Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.