Provider Demographics
NPI:1659542017
Name:FIFTH AVENUE CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:FIFTH AVENUE CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUNIUS
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SOLIDAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:717-263-6101
Mailing Address - Street 1:761 5TH AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4210
Mailing Address - Country:US
Mailing Address - Phone:717-263-6101
Mailing Address - Fax:717-263-6202
Practice Address - Street 1:761 5TH AVE
Practice Address - Street 2:SUITE F
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4210
Practice Address - Country:US
Practice Address - Phone:717-263-6101
Practice Address - Fax:717-263-6202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-004211-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA065926Medicare PIN