Healthcare Provider Details

I. General information

NPI: 1851390652
Provider Name (Legal Business Name): MARK J. DOODY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 08/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 S MARKET ST
ELIZABETHTOWN PA
17022-2308
US

IV. Provider business mailing address

29 S MARKET ST
ELIZABETHTOWN PA
17022-2308
US

V. Phone/Fax

Practice location:
  • Phone: 717-367-3100
  • Fax: 717-367-9200
Mailing address:
  • Phone: 717-367-3100
  • Fax: 717-367-9200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number730
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC009985
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4280
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: