=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215111851
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FROEHLICH CHIROPRACTIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2007
-----------------------------------------------------
Last Update Date | 12/18/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 605 SAINT JOHNS RD
-----------------------------------------------------
City | CAMP HILL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17011-6829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-910-8042
-----------------------------------------------------
Fax | 717-388-8808
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1540 SCALP AVE STE 104
-----------------------------------------------------
City | JOHNSTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15904-3309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-467-9442
-----------------------------------------------------
Fax | 814-248-3314
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MATTHEW THOMAS FROEHLICH
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 717-910-8042
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC008997
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------