=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558309294
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTIE FAMILY CHIROPRACTIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2006
-----------------------------------------------------
Last Update Date | 09/24/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3359 W 38TH ST
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16506-4203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-838-3830
-----------------------------------------------------
Fax | 814-838-3831
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3359 W 38TH ST
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16506-4203
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-838-3830
-----------------------------------------------------
Fax | 814-838-3831
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ERIC N CHRISTIE
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 814-838-3830
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC-007099-L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------