Provider Demographics
NPI:1184079147
Name:ELIZABETHTOWN FAMILY CHIROPRACTIC PC
Entity type:Organization
Organization Name:ELIZABETHTOWN FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:YOCUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-367-5777
Mailing Address - Street 1:1077 DAIRY LN
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-9547
Mailing Address - Country:US
Mailing Address - Phone:717-367-5777
Mailing Address - Fax:717-367-0556
Practice Address - Street 1:1077 DAIRY LN
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-9547
Practice Address - Country:US
Practice Address - Phone:717-367-5777
Practice Address - Fax:717-367-0556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006285L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA417786Medicare UPIN