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General NPI Number Information
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NPI Number | 1902296254
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Entity Type | Organization
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Legal Business Name | LEWISBURG FAMILY CHIROPRACTIC
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Dates
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Enumeration Date | 01/26/2015
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Last Update Date | 07/30/2018
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Provider Practice Location Address
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Address Line | 200 MARKET ST
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City | LEWISBURG
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State | PA
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Zip | 17837
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Country | US
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Telephone | 570-523-9609
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Fax | 570-300-1888
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Provider Business Mailing Address
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Address Line | 200 MARKET ST
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City | LEWISBURG
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State | PA
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Zip | 17837-1544
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Country | US
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Telephone | 570-523-9609
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Fax | 570-300-1888
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. ANTHONY DEWALD
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Credential | DC
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Telephone | 570-523-9609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | DC010975
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License Number State | PA
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