Provider Demographics
NPI:1104285055
Name:LEGACY WELLNESS & CHIROPRACTIC
Entity type:Organization
Organization Name:LEGACY WELLNESS & CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLAINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-916-6332
Mailing Address - Street 1:2209 FOREST HILLS DR
Mailing Address - Street 2:STE 22
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-1095
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2209 FOREST HILLS DR
Practice Address - Street 2:SUITE 22
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-1095
Practice Address - Country:US
Practice Address - Phone:717-657-1620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-21
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010958111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty