Provider Demographics
NPI:1710434501
Name:BLOOMSBURG FAMILY CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:BLOOMSBURG FAMILY CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ARDO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-784-2282
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-0036
Mailing Address - Country:US
Mailing Address - Phone:570-784-2282
Mailing Address - Fax:570-784-2332
Practice Address - Street 1:1000 MARKET ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-2600
Practice Address - Country:US
Practice Address - Phone:570-784-2282
Practice Address - Fax:570-784-2332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010806111N00000X, 261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitationGroup - Single Specialty