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General NPI Number Information
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NPI Number | 1417233602
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Entity Type | Organization
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Legal Business Name | SUSQUEHANNA VALLEY CHIROPRACTIC AND REHABILITATION
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Dates
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Enumeration Date | 11/01/2011
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Last Update Date | 11/01/2011
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Provider Practice Location Address
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Address Line | 236 N GEORGE ST SUITE 105
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City | YORK
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State | PA
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Zip | 17401-1108
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Country | US
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Telephone | 717-515-8116
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Fax | 717-650-2547
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Provider Business Mailing Address
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Address Line | 100 DEW DROP CT
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City | YORK
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State | PA
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Zip | 17403-4940
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Country | US
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Telephone | 717-515-8116
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Fax | 717-650-2547
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. JARED DANIEL STUBBLEFIELD
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Credential | D.C.
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Telephone | 717-515-8116
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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 | DC010295
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License Number State | PA
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