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General NPI Number Information
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NPI Number | 1568504090
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Entity Type | Organization
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Legal Business Name | MIFFLINTOWN FAMILY CHIROPRACTIC, PC
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 10 WEATHERBY WAY
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City | MIFFLINTOWN
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State | PA
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Zip | 17059-8901
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Country | US
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Telephone | 717-436-9017
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Fax | 717-436-5695
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Provider Business Mailing Address
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Address Line | 138 WEATHERBY WAY
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City | MIFFLINTOWN
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State | PA
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Zip | 17059-8902
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Country | US
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Telephone | 717-436-9017
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Fax | 717-436-5695
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK ANTHONY DEBENEDETTO
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Credential | D.C.
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Telephone | 717-242-1215
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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 | DC004818-L
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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 | DC004647-L
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License Number State | PA
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