Provider Demographics
NPI:1386799898
Name:YORK CHIROPRACTIC INC.
Entity type:Organization
Organization Name:YORK CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-684-5504
Mailing Address - Street 1:809 E LIBERTY ST
Mailing Address - Street 2:PO BOX 297
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-1661
Mailing Address - Country:US
Mailing Address - Phone:803-684-5504
Mailing Address - Fax:803-684-5496
Practice Address - Street 1:809 E LIBERTY ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-1661
Practice Address - Country:US
Practice Address - Phone:803-684-5504
Practice Address - Fax:803-684-5496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC3664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC=========OtherEIN
SC=========OtherEIN
SCT924883664Medicare UPIN