Provider Demographics
NPI:1669547865
Name:ROTHSVILLE CHIROPRACTIC
Entity type:Organization
Organization Name:ROTHSVILLE CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:MUDRYK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-626-0466
Mailing Address - Street 1:1749 OLD ROTHSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-9036
Mailing Address - Country:US
Mailing Address - Phone:717-626-0466
Mailing Address - Fax:
Practice Address - Street 1:1749 OLD ROTHSVILLE RD
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-9036
Practice Address - Country:US
Practice Address - Phone:717-626-0466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001688L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty