Provider Demographics
NPI:1871885418
Name:SSOR, INC
Entity type:Organization
Organization Name:SSOR, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BEDESEM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-925-1078
Mailing Address - Street 1:531 BURNHAM CT
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-7403
Mailing Address - Country:US
Mailing Address - Phone:717-925-1078
Mailing Address - Fax:
Practice Address - Street 1:531 BURNHAM CT
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-7403
Practice Address - Country:US
Practice Address - Phone:717-925-1078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-13
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002899L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1093022410OtherMEDICARE TYPE I NPI