Provider Demographics
NPI:1689855397
Name:ELANCO CHIROPRACTIC & REHABILITATION CENTER, INC.
Entity Type:Organization
Organization Name:ELANCO CHIROPRACTIC & REHABILITATION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GREVE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-355-5000
Mailing Address - Street 1:1907 DIVISION HWY
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-8947
Mailing Address - Country:US
Mailing Address - Phone:717-355-5000
Mailing Address - Fax:717-354-8587
Practice Address - Street 1:1907 DIVISION HWY
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-8947
Practice Address - Country:US
Practice Address - Phone:717-355-5000
Practice Address - Fax:717-354-8587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-007-057-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA087523Medicare PIN