Individual
DR. LYNNITA M TIGUE-PETROSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
98 FOREST DR, SUITE 2, LORDS VALLEY, PA 18428-6140
(570) 775-6205
(570) 775-6205
Mailing address
98 FOREST DR, SUITE 2, LORDS VALLEY, PA 18428-6140
(570) 775-6205
(570) 775-6205
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC008740
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
056426TEX
MEDICARE PTAN
PA
05
—
1012312930001
—
PA
01
—
1640258
BLUE SHIELD
PA
01
—
201331634
TAX ID
PA
01
—
818148
FIRST PRIORITY
PA
Enumeration date
12/12/2006
Last updated
03/26/2012
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