Provider Demographics
NPI:1497464457
Name:SOMERVILLE, CODY BENJAMIN (DC)
Entity Type:Individual
Prefix:DR
First Name:CODY
Middle Name:BENJAMIN
Last Name:SOMERVILLE
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 1:1776 S QUEEN ST # 101B
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-4628
Mailing Address - Country:US
Mailing Address - Phone:717-848-5400
Mailing Address - Fax:
Practice Address - Street 1:1776 S QUEEN ST # 101B
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4628
Practice Address - Country:US
Practice Address - Phone:717-848-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011787111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor