Provider Demographics
NPI:1194027615
Name:FAMILY TREE CHIROPRACTIC MT JOY LLC
Entity Type:Organization
Organization Name:FAMILY TREE CHIROPRACTIC MT JOY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BRYSON
Authorized Official - Suffix:
Authorized Official - Credentials:CSA, CLTC, CPL
Authorized Official - Phone:717-808-4484
Mailing Address - Street 1:1013 W MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MOUNT JOY
Mailing Address - State:PA
Mailing Address - Zip Code:17552-9699
Mailing Address - Country:US
Mailing Address - Phone:717-808-4484
Mailing Address - Fax:
Practice Address - Street 1:1013 W MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:MOUNT JOY
Practice Address - State:PA
Practice Address - Zip Code:17552-9699
Practice Address - Country:US
Practice Address - Phone:717-808-4484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Single Specialty
No111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Single Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty