Provider Demographics
NPI:1447431382
Name:LANDIS, DAVID H (DC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:H
Last Name:LANDIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:PA
Mailing Address - Zip Code:17512
Mailing Address - Country:US
Mailing Address - Phone:717-684-3426
Mailing Address - Fax:
Practice Address - Street 1:547 LOCUST ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:PA
Practice Address - Zip Code:17512
Practice Address - Country:US
Practice Address - Phone:717-684-3426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001524L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA158850Medicare UPIN
T29763Medicare PIN