Provider Demographics
NPI:1023071628
Name:WELLCARE CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:WELLCARE CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-533-0881
Mailing Address - Street 1:475 W GOVERNOR RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2217
Mailing Address - Country:US
Mailing Address - Phone:717-533-0881
Mailing Address - Fax:717-533-2155
Practice Address - Street 1:475 W GOVERNOR RD
Practice Address - Street 2:SUITE 3
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2217
Practice Address - Country:US
Practice Address - Phone:717-533-0881
Practice Address - Fax:717-533-2155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1639143068OtherROBIN MCCONNELL NPI
PA1144295601OtherDANIEL KOVAL NPI
PA1558336859OtherPENNY KOVAL NPI