Provider Demographics
NPI:1972004893
Name:FULTON COUNTY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:FULTON COUNTY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHETLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-485-9000
Mailing Address - Street 1:425 E PINE ST
Mailing Address - Street 2:
Mailing Address - City:MC CONNELLSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17233-1437
Mailing Address - Country:US
Mailing Address - Phone:717-485-9000
Mailing Address - Fax:717-485-9016
Practice Address - Street 1:425 E PINE ST
Practice Address - Street 2:
Practice Address - City:MC CONNELLSBURG
Practice Address - State:PA
Practice Address - Zip Code:17233-1437
Practice Address - Country:US
Practice Address - Phone:717-485-9000
Practice Address - Fax:717-485-9016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008992111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty