1649434176 NPI number — DILLSBURG CHIROPRACTIC CENTER INC.

Table of content: (NPI 1649434176)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649434176 NPI number — DILLSBURG CHIROPRACTIC CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DILLSBURG CHIROPRACTIC CENTER INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649434176
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23684 BAYVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWES
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19958-3228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-805-9410
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 TRISTAN DR STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DILLSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17019-1632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-502-0909
Provider Business Practice Location Address Fax Number:
717-502-0013
Provider Enumeration Date:
07/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RENYO
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
CLIFFORD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
717-502-0909

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC003410L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: T72913 . This is a "UPIN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com