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General NPI Number Information
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NPI Number | 1487020624
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Entity Type | Organization
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Legal Business Name | WELLSPINE CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 08/11/2015
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Last Update Date | 08/11/2015
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Provider Practice Location Address
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Address Line | 4400 LINGLESTOWN RD 108
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City | HARRISBURG
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State | PA
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Zip | 17112-8507
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Country | US
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Telephone | 717-500-1203
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Fax | 717-406-1567
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Provider Business Mailing Address
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Address Line | 4400 LINGLESTOWN RD 108
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City | HARRISBURG
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State | PA
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Zip | 17112-8507
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Country | US
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Telephone | 717-500-1203
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Fax | 717-406-1567
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Authorized Official
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Title or Position | OWNER
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Name | DR. MATTHEW RICHARDSON
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Credential | DC
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Telephone | 717-500-1203
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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 | 010794
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License Number State | PA
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