Provider Demographics
NPI:1043687916
Name:LEWISBURG SPORT & SPINE CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:LEWISBURG SPORT & SPINE CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LONNI
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:ERNST DANCY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-412-2090
Mailing Address - Street 1:114 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-1542
Mailing Address - Country:US
Mailing Address - Phone:570-768-4026
Mailing Address - Fax:570-768-4029
Practice Address - Street 1:114 MARKET ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-1542
Practice Address - Country:US
Practice Address - Phone:570-412-2090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011061111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty