Healthcare Provider Details

I. General information

NPI: 1982087201
Provider Name (Legal Business Name): FUSION CHIROPRACTIC & ACUPUNCTURE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2015
Last Update Date: 07/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 EASTERLY PKWY SUITE 105
STATE COLLEGE PA
16801-6300
US

IV. Provider business mailing address

233 EASTERLY PKWY SUITE 105
STATE COLLEGE PA
16801-6300
US

V. Phone/Fax

Practice location:
  • Phone: 814-592-7529
  • Fax: 814-643-0987
Mailing address:
  • Phone: 814-592-7529
  • Fax: 814-643-0987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC010703
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAK001081
License Number StatePA

VIII. Authorized Official

Name: DR. HEATHER RAE FERLITCH
Title or Position: OWNER
Credential: DC, MS, LLC
Phone: 814-592-7529