Provider Demographics
NPI:1871998195
Name:MID-ATLANTIC CHIROPRACTIC WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:MID-ATLANTIC CHIROPRACTIC WELLNESS CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCNEW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-261-0802
Mailing Address - Street 1:1982 SCOTLAND AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-1450
Mailing Address - Country:US
Mailing Address - Phone:717-261-0802
Mailing Address - Fax:717-261-0892
Practice Address - Street 1:1982 SCOTLAND AVE
Practice Address - Street 2:UNIT B
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1450
Practice Address - Country:US
Practice Address - Phone:717-261-0802
Practice Address - Fax:717-261-0892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007935L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU84201Medicare UPIN