Provider Demographics
NPI:1265629703
Name:CHIROPRACTIC HEAD&NECK TREATMENT CENTER
Entity Type:Organization
Organization Name:CHIROPRACTIC HEAD&NECK TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-355-5575
Mailing Address - Street 1:427 W MAIN ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:NEW HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17557-1143
Mailing Address - Country:US
Mailing Address - Phone:717-355-5575
Mailing Address - Fax:717-355-5576
Practice Address - Street 1:427 W MAIN ST
Practice Address - Street 2:SUITE I
Practice Address - City:NEW HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:17557-1143
Practice Address - Country:US
Practice Address - Phone:717-355-5575
Practice Address - Fax:717-355-5576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001572L261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA98063Medicare PIN