Provider Demographics
NPI:1417233602
Name:SUSQUEHANNA VALLEY CHIROPRACTIC AND REHABILITATION
Entity Type:Organization
Organization Name:SUSQUEHANNA VALLEY CHIROPRACTIC AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:STUBBLEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-515-8116
Mailing Address - Street 1:100 DEW DROP CT
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-4940
Mailing Address - Country:US
Mailing Address - Phone:717-515-8116
Mailing Address - Fax:717-650-2547
Practice Address - Street 1:236 N GEORGE ST
Practice Address - Street 2:SUITE 105
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17401-1108
Practice Address - Country:US
Practice Address - Phone:717-515-8116
Practice Address - Fax:717-650-2547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010295111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty