Provider Demographics
NPI:1871631887
Name:ADVANTAGE CHIROPRACTIC
Entity Type:Organization
Organization Name:ADVANTAGE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:DOODY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-367-3100
Mailing Address - Street 1:29 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-2308
Mailing Address - Country:US
Mailing Address - Phone:717-367-3100
Mailing Address - Fax:717-367-9200
Practice Address - Street 1:29 S MARKET ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-2308
Practice Address - Country:US
Practice Address - Phone:717-367-3100
Practice Address - Fax:717-367-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7419211OtherAETNA PROVIDER NUMBER
U83177Medicare UPIN