Provider Demographics
NPI:1790792448
Name:HERSHNER-DECKER, KRISTA JO (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:JO
Last Name:HERSHNER-DECKER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 284
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17342
Mailing Address - Country:US
Mailing Address - Phone:717-428-2716
Mailing Address - Fax:717-428-2716
Practice Address - Street 1:103 ORE ST
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17342
Practice Address - Country:US
Practice Address - Phone:717-428-2716
Practice Address - Fax:717-428-2716
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007132L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U69134Medicare UPIN
PAHE005752Medicare ID - Type Unspecified