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General NPI Number Information
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NPI Number | 1184079147
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Entity Type | Organization
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Legal Business Name | ELIZABETHTOWN FAMILY CHIROPRACTIC PC
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Dates
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Enumeration Date | 04/27/2016
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Last Update Date | 04/27/2016
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Provider Practice Location Address
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Address Line | 1077 DAIRY LN
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City | ELIZABETHTOWN
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State | PA
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Zip | 17022-9547
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Country | US
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Telephone | 717-367-5777
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Fax | 717-367-0556
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Provider Business Mailing Address
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Address Line | 1077 DAIRY LN
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City | ELIZABETHTOWN
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State | PA
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Zip | 17022-9547
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Country | US
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Telephone | 717-367-5777
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Fax | 717-367-0556
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEITH RAY YOCUM
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Credential | D.C.
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Telephone | 717-367-5777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC006285L
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License Number State | PA
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