Provider Demographics
NPI:1427340470
Name:GENTLE HANDS CHIROPRACTIC PC
Entity type:Organization
Organization Name:GENTLE HANDS CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RANI
Authorized Official - Middle Name:HEATHER
Authorized Official - Last Name:WADDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:717-926-1166
Mailing Address - Street 1:456 E CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-8118
Mailing Address - Country:US
Mailing Address - Phone:717-926-1166
Mailing Address - Fax:717-272-2326
Practice Address - Street 1:456 E CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-8118
Practice Address - Country:US
Practice Address - Phone:717-926-1166
Practice Address - Fax:717-272-2326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009034111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA079589SS1OtherMEDICARE ID - TYPE UNSPECIFIED
PA50037855OtherBLUE CROSS
PAWA1604188OtherBLUE SHIELD
PA50037855OtherBLUE CROSS