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General NPI Number Information
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NPI Number | 1700208212
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Entity Type | Organization
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Legal Business Name | LEBANON CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 01/17/2014
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Last Update Date | 01/17/2014
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Provider Practice Location Address
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Address Line | 2234 CUMBERLAND ST
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City | LEBANON
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State | PA
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Zip | 17042-2583
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Country | US
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Telephone | 717-273-3741
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Fax |
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Provider Business Mailing Address
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Address Line | 2234 CUMBERLAND ST
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City | LEBANON
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State | PA
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Zip | 17042-2583
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Country | US
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Telephone | 717-273-3741
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JARED STUBBLEFIELD
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Credential |
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Telephone | 717-273-3741
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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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