Provider Demographics
NPI:1184848236
Name:HUSTON FAMILY CHIROPRACTIC AND WELLNESS CENTER
Entity Type:Organization
Organization Name:HUSTON FAMILY CHIROPRACTIC AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARISSE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-541-9668
Mailing Address - Street 1:6100 JONESTOWN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-2632
Mailing Address - Country:US
Mailing Address - Phone:717-541-9668
Mailing Address - Fax:717-541-9669
Practice Address - Street 1:6100 JONESTOWN RD
Practice Address - Street 2:SUITE A
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-2632
Practice Address - Country:US
Practice Address - Phone:717-541-9668
Practice Address - Fax:717-541-9669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-006569-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU28098Medicare UPIN
PA047162Medicare PIN