Provider Demographics
NPI:1841420239
Name:NEBIKER CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:NEBIKER CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:NEBIKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-966-3600
Mailing Address - Street 1:303 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:MIFFLINBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17844-9678
Mailing Address - Country:US
Mailing Address - Phone:570-966-3600
Mailing Address - Fax:570-966-3600
Practice Address - Street 1:303 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:MIFFLINBURG
Practice Address - State:PA
Practice Address - Zip Code:17844-9678
Practice Address - Country:US
Practice Address - Phone:570-966-3600
Practice Address - Fax:570-966-3600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA003963L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PANE574175OtherBLUE SHIELD
PA0011883960002Medicaid
PANE574175OtherBLUE SHIELD