Provider Demographics
NPI:1659454353
Name:ELIZABETHTOWN FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:ELIZABETHTOWN FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-367-5777
Mailing Address - Street 1:1077 DAIRY LANE
Mailing Address - Street 2:ELIZABETHTOWN FAMILY CHIROPRACTIC
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022
Mailing Address - Country:US
Mailing Address - Phone:717-367-5777
Mailing Address - Fax:717-367-0556
Practice Address - Street 1:1077 DAIRY LANE
Practice Address - Street 2:ELIZABETHTOWN FAMILY CHIROPRACTIC
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022
Practice Address - Country:US
Practice Address - Phone:717-367-5777
Practice Address - Fax:717-367-0556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001375L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAEL362295OtherBLUE CROSS BLUE SHIELD
11235Medicare ID - Type Unspecified