Provider Demographics
NPI:1093771966
Name:BEDFORD FAMILY CHIROPRACTIC CENTER, P.C.
Entity Type:Organization
Organization Name:BEDFORD FAMILY CHIROPRACTIC CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-623-3300
Mailing Address - Street 1:153 LINGENFELTER RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15522-6636
Mailing Address - Country:US
Mailing Address - Phone:814-623-3300
Mailing Address - Fax:
Practice Address - Street 1:153 LINGENFELTER RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522-6636
Practice Address - Country:US
Practice Address - Phone:814-623-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008748420001Medicaid
PA1008748420001Medicaid