Provider Demographics
NPI:1568419646
Name:CHIROPRACTIC 1ST LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC 1ST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-569-5075
Mailing Address - Street 1:245 BLOOMFIELD DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-7789
Mailing Address - Country:US
Mailing Address - Phone:717-569-5075
Mailing Address - Fax:717-569-5030
Practice Address - Street 1:245 BLOOMFIELD DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-7789
Practice Address - Country:US
Practice Address - Phone:717-569-5075
Practice Address - Fax:717-569-5030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008857111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001471947OtherHIGHMARK PROVIDER NUMBER
PA264884OtherHEALTHASSURANCE PROVIDER
PA3741100OtherAETNA PROVIDER NUMBER
PA089077Medicare PIN
PAU94635Medicare UPIN