Provider Demographics
NPI:1679611693
Name:BURKHOLDER CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:BURKHOLDER CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURKHOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-738-3474
Mailing Address - Street 1:305 N READING RD
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-1653
Mailing Address - Country:US
Mailing Address - Phone:717-738-3474
Mailing Address - Fax:717-738-8087
Practice Address - Street 1:305 N READING RD
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1653
Practice Address - Country:US
Practice Address - Phone:717-738-3474
Practice Address - Fax:717-738-8087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC8611111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02978600OtherCAPITAL BLUE CROSS
PA7361277OtherAETNA POS PPO
PA77675990005OtherCIGNA
PA3745547OtherAETNA HMO
PA1005195OtherAMERICAN SPECIALTY HEALTH
PABU1670931OtherHIGHMERK BLUE SHIELD
PA3745547OtherAETNA HMO
PA053885Medicare ID - Type UnspecifiedMEDICARE NUMBER