Provider Demographics
NPI:1497785638
Name:RED LION CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:RED LION CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP PRES; D.C.
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-840-0888
Mailing Address - Street 1:631 LOMBARD RD
Mailing Address - Street 2:
Mailing Address - City:RED LION
Mailing Address - State:PA
Mailing Address - Zip Code:17356-9054
Mailing Address - Country:US
Mailing Address - Phone:717-840-0888
Mailing Address - Fax:717-840-4369
Practice Address - Street 1:631 LOMBARD RD
Practice Address - Street 2:
Practice Address - City:RED LION
Practice Address - State:PA
Practice Address - Zip Code:17356-9054
Practice Address - Country:US
Practice Address - Phone:717-840-0888
Practice Address - Fax:717-840-4369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002379L111N00000X
PADC006112L111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT28385Medicare UPIN
PAU55138Medicare UPIN
PAU96458Medicare UPIN