Provider Demographics
NPI:1679542534
Name:ANTOLICK CHIROPRACTIC HEALTH CENTER
Entity Type:Organization
Organization Name:ANTOLICK CHIROPRACTIC HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANTOLICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-227-1028
Mailing Address - Street 1:518B S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17361-1739
Mailing Address - Country:US
Mailing Address - Phone:717-227-1028
Mailing Address - Fax:717-227-1029
Practice Address - Street 1:518B S MAIN ST
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:PA
Practice Address - Zip Code:17361-1739
Practice Address - Country:US
Practice Address - Phone:717-227-1028
Practice Address - Fax:717-227-1029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009490111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAV07470Medicare UPIN
PA096264US1Medicare ID - Type Unspecified