Provider Demographics
NPI:1700060811
Name:HARRISBURG FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:HARRISBURG FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:BROOKS
Authorized Official - Last Name:MAYLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-767-7463
Mailing Address - Street 1:303 W WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:SD
Mailing Address - Zip Code:57032-2004
Mailing Address - Country:US
Mailing Address - Phone:605-767-7463
Mailing Address - Fax:605-767-7464
Practice Address - Street 1:303 W WILLOW ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:SD
Practice Address - Zip Code:57032-2004
Practice Address - Country:US
Practice Address - Phone:605-767-7463
Practice Address - Fax:605-767-7464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1076111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD100894Medicare PIN