Healthcare Provider Details

I. General information

NPI: 1275837387
Provider Name (Legal Business Name): FAMILY TREE CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2011
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 DAWN AVE
EPHRATA PA
17522-1340
US

IV. Provider business mailing address

904 DAWN AVE
EPHRATA PA
17522-1340
US

V. Phone/Fax

Practice location:
  • Phone: 717-738-2555
  • Fax: 717-738-2557
Mailing address:
  • Phone: 717-738-2555
  • Fax: 717-738-2557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC003403L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License NumberDC003403L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License NumberDC003403L
License Number StatePA

VIII. Authorized Official

Name: DR. DAVID S PARKER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 717-738-2555