Healthcare Provider Details

I. General information

NPI: 1558500355
Provider Name (Legal Business Name): COMPLETE HEALTH CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 10/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 COCOA AVE
HERSHEY PA
17033-1712
US

IV. Provider business mailing address

1106 COCOA AVE
HERSHEY PA
17033-1712
US

V. Phone/Fax

Practice location:
  • Phone: 717-979-5424
  • Fax:
Mailing address:
  • Phone: 717-520-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC008960
License Number StatePA

VIII. Authorized Official

Name: ROBIN K. MCCONNELL
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 717-520-1212