Provider Demographics
NPI:1891810040
Name:SOUTHERN YORK COUNTY CHIROPRACTIC
Entity Type:Organization
Organization Name:SOUTHERN YORK COUNTY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-235-8855
Mailing Address - Street 1:40 WATER ST
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:PA
Mailing Address - Zip Code:17327-1011
Mailing Address - Country:US
Mailing Address - Phone:717-235-8855
Mailing Address - Fax:717-235-8850
Practice Address - Street 1:40 WATER ST
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:PA
Practice Address - Zip Code:17327-1011
Practice Address - Country:US
Practice Address - Phone:717-235-8855
Practice Address - Fax:717-235-8850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007378L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASO1351319OtherPA BLUE SHIELD