Provider Demographics
NPI:1265570675
Name:HAVERSTICK, HARVEY LESTER JR (DC)
Entity type:Individual
Prefix:
First Name:HARVEY
Middle Name:LESTER
Last Name:HAVERSTICK
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WEST FIFTH ST
Mailing Address - Street 2:
Mailing Address - City:QUARRYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17566
Mailing Address - Country:US
Mailing Address - Phone:717-786-7201
Mailing Address - Fax:717-786-2359
Practice Address - Street 1:12 WEST FIFTH ST
Practice Address - Street 2:
Practice Address - City:QUARRYVILLE
Practice Address - State:PA
Practice Address - Zip Code:17566
Practice Address - Country:US
Practice Address - Phone:717-786-7201
Practice Address - Fax:717-786-2359
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003133L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAHA571550Medicare ID - Type Unspecified