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General NPI Number Information
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NPI Number | 1497785638
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Entity Type | Organization
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Legal Business Name | RED LION CHIROPRACTIC, INC.
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 02/03/2022
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Provider Practice Location Address
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Address Line | 631 LOMBARD RD
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City | RED LION
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State | PA
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Zip | 17356-9054
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Country | US
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Telephone | 717-840-0888
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Fax | 717-840-4369
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Provider Business Mailing Address
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Address Line | 631 LOMBARD RD
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City | RED LION
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State | PA
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Zip | 17356-9054
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Country | US
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Telephone | 717-840-0888
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Fax | 717-840-4369
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Authorized Official
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Title or Position | CORP PRES; D.C.
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Name | DR. JOSEPH ALLAN FULLER
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Credential | D.C.
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Telephone | 717-840-0888
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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 | DC006112L
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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 | DC002379L
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License Number State | PA
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