Provider Demographics
NPI:1194994830
Name:LANDIS FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:LANDIS FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:LANDIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-684-3426
Mailing Address - Street 1:547 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:PA
Mailing Address - Zip Code:17512
Mailing Address - Country:US
Mailing Address - Phone:717-684-3426
Mailing Address - Fax:
Practice Address - Street 1:547 LOCUST ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:PA
Practice Address - Zip Code:17512
Practice Address - Country:US
Practice Address - Phone:717-684-3426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001524L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA158850OtherBCBS
PA158850Medicaid
PA158850OtherBCBS