NPIMap

Organization Active NPI

Radiance Chiropractic

  • Chiropractor
  • Canonsburg, PA
National Provider Identifier
1417466384
Registry record updated May 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4148L Issued in PA
Legal business name
RADIANCE CHIROPRACTIC
Practice address
370 Southpointe Blvd Ste 100
Canonsburg, PA 15317-8572
Phone
(724) 942-4444
Fax
(724) 338-4483
NPI assigned
Sep 23, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2019

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

Authorized official

Name
Dr. Laurel Gretz Pisciottano, DCNPI 1114991247
Title
Clinic Director
Phone
(724) 942-4444

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 4148L PA Primary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X

Addresses

Primary practice location

370 Southpointe Blvd Ste 100
Canonsburg, PA 15317-8572

Mailing address

370 Southpointe Blvd Ste 100
Canonsburg, PA 15317-8572
Phone (724) 942-4444

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171121003009 PA Part B Supplier - Clinic/Group Practice 9032476346 Receives reassigned benefits from 3 practitioners
Practice locations: Canonsburg, PA; Pittsburgh, PA

National Provider Directory

National Provider Directory

Locations

333 Technology Dr
Ste 205
Canonsburg, PA 15317

370 Southpointe Blvd
Ste 100
Canonsburg, PA 15317
Phone (724) 873-8932

701 Technology Dr
Ste 50
Canonsburg, PA 15317

4500 Clairton Blvd
Ste 1
Pittsburgh, PA 15236
Phone (412) 469-2000

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1506124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1558483200000",
    "number": "1417466384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "370 SOUTHPOINTE BLVD STE 100",
            "city": "CANONSBURG",
            "state": "PA",
            "postal_code": "153178572",
            "telephone_number": "724-942-4444",
            "fax_number": "724-338-4483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "370 SOUTHPOINTE BLVD STE 100",
            "city": "CANONSBURG",
            "state": "PA",
            "postal_code": "153178572",
            "telephone_number": "724-942-4444",
            "fax_number": "724-338-4483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIANCE CHIROPRACTIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-23",
        "last_updated": "2019-05-22",
        "status": "A",
        "authorized_official_last_name": "GRETZ PISCIOTTANO",
        "authorized_official_first_name": "LAUREL",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "724-942-4444",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "4148L",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canonsburg, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.