Provider Demographics
NPI:1770612954
Name:EHRHART, BRIAN D (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:D
Last Name:EHRHART
Suffix:
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 1:2180 WHITE ST # 110
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-4952
Mailing Address - Country:US
Mailing Address - Phone:717-854-9355
Mailing Address - Fax:717-845-7956
Practice Address - Street 1:804 LOUCKS RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-1928
Practice Address - Country:US
Practice Address - Phone:717-854-9355
Practice Address - Fax:717-845-7956
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-001344-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00630700Medicaid
PAEH1418220OtherBLUE SHIELD
T29066Medicare UPIN
PAEH1418220OtherBLUE SHIELD