Provider Demographics
NPI:1114988755
Name:HETRICK CENTER PC
Entity Type:Organization
Organization Name:HETRICK CENTER PC
Other - Org Name:THE HETRICK CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:R
Authorized Official - Last Name:HETRICK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:717-944-2225
Mailing Address - Street 1:500 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17057
Mailing Address - Country:US
Mailing Address - Phone:717-944-2225
Mailing Address - Fax:717-944-0932
Practice Address - Street 1:500 N UNION ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:PA
Practice Address - Zip Code:17057
Practice Address - Country:US
Practice Address - Phone:717-944-2225
Practice Address - Fax:717-944-0932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
02317900OtherCBC
02317900OtherCBC