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General NPI Number Information
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NPI Number | 1316017247
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Entity Type | Organization
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Legal Business Name | ALTOONA CHIROPRACTIC LIFE CENTER INC.
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1405 EAST WALTON AVENUE
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City | ALTOONA
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State | PA
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Zip | 16602
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Country | US
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Telephone | 814-946-0279
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Fax | 814-946-9039
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Provider Business Mailing Address
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Address Line | 1405 EAST WALTON AVENUE
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City | ALTOONA
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State | PA
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Zip | 16602
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Country | US
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Telephone | 814-946-0279
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Fax | 814-946-9039
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HARRY JOSEPH FYE JR.
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Credential | D.C.
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Telephone | 814-946-0279
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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 | DC009194
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC001390-L
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License Number State | PA
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