Provider Demographics
NPI:1598853657
Name:MOYER, ALICE BANKHART (DC)
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:BANKHART
Last Name:MOYER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 114 MAIN STREET
Mailing Address - Street 2:EAST SMITHFIELD HEALTHCARE
Mailing Address - City:EAST SMITHFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:18817-0114
Mailing Address - Country:US
Mailing Address - Phone:570-596-7076
Mailing Address - Fax:570-596-7076
Practice Address - Street 1:MAIN STREET
Practice Address - Street 2:
Practice Address - City:EAST SMITHFIELD
Practice Address - State:PA
Practice Address - Zip Code:18817
Practice Address - Country:US
Practice Address - Phone:570-596-7076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002709L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA057269Medicare ID - Type Unspecified