Provider Demographics
NPI:1811014178
Name:ULTRAHEALTH CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:ULTRAHEALTH CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:RIES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-396-9440
Mailing Address - Street 1:104 S CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-9731
Mailing Address - Country:US
Mailing Address - Phone:717-396-9440
Mailing Address - Fax:
Practice Address - Street 1:104 S CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-9731
Practice Address - Country:US
Practice Address - Phone:717-396-9440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007648L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001886077000Medicaid
PAUL058883Medicare ID - Type Unspecified
PA001886077000Medicaid