Provider Demographics
NPI:1619041068
Name:SEESHOLTZ CHIROPRACTIC
Entity Type:Organization
Organization Name:SEESHOLTZ CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SEESHOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-784-2529
Mailing Address - Street 1:2607 OLD BERWICK RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-3238
Mailing Address - Country:US
Mailing Address - Phone:570-784-2529
Mailing Address - Fax:570-784-1001
Practice Address - Street 1:2607 OLD BERWICK RD
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-3238
Practice Address - Country:US
Practice Address - Phone:570-784-2529
Practice Address - Fax:570-784-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008704111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU96358Medicare UPIN
PA072046Medicare ID - Type UnspecifiedCHIROPRACTIC