Provider Demographics
NPI:1841463940
Name:CAPITAL CHIROPRACTIC CENTER, PC
Entity type:Organization
Organization Name:CAPITAL CHIROPRACTIC CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:REMILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-558-9292
Mailing Address - Street 1:4079 DERRY ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-2347
Mailing Address - Country:US
Mailing Address - Phone:717-558-9292
Mailing Address - Fax:717-558-2006
Practice Address - Street 1:4079 DERRY ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-2347
Practice Address - Country:US
Practice Address - Phone:717-558-9292
Practice Address - Fax:717-558-2006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007090L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARE000955OtherMEDICARE