Provider Demographics
NPI:1437224565
Name:FOREST HILLTOP CHIROPRACTIC ASSOC.
Entity Type:Organization
Organization Name:FOREST HILLTOP CHIROPRACTIC ASSOC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BOSSERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-255-7292
Mailing Address - Street 1:1837 GOUCHER ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-9506
Mailing Address - Country:US
Mailing Address - Phone:814-255-7292
Mailing Address - Fax:814-255-6742
Practice Address - Street 1:1837 GOUCHER ST
Practice Address - Street 2:SUITE #1
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-9506
Practice Address - Country:US
Practice Address - Phone:814-255-7292
Practice Address - Fax:814-255-6742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007072-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty