Healthcare Provider Details

I. General information

NPI: 1194027615
Provider Name (Legal Business Name): FAMILY TREE CHIROPRACTIC MT JOY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2010
Last Update Date: 12/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 W MAIN ST STE 1
MOUNT JOY PA
17552-9699
US

IV. Provider business mailing address

1013 W MAIN ST STE 1
MOUNT JOY PA
17552-9699
US

V. Phone/Fax

Practice location:
  • Phone: 717-808-4484
  • Fax:
Mailing address:
  • Phone: 717-808-4484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN S BRYSON
Title or Position: CEO
Credential: CSA, CLTC, CPL
Phone: 717-808-4484