Provider Demographics
NPI:1699978973
Name:ELITE FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:ELITE FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:DERR
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:570-374-2898
Mailing Address - Street 1:119 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-1905
Mailing Address - Country:US
Mailing Address - Phone:570-374-2898
Mailing Address - Fax:570-374-2408
Practice Address - Street 1:119 N MARKET ST
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-1905
Practice Address - Country:US
Practice Address - Phone:570-374-2898
Practice Address - Fax:570-374-2408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009491111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA099629Medicare ID - Type UnspecifiedCHIROPRACTOR