Provider Demographics
NPI:1912069477
Name:HOUSEKNECHT, DAVID M (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:HOUSEKNECHT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 FERRY ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-1571
Mailing Address - Country:US
Mailing Address - Phone:570-275-6325
Mailing Address - Fax:570-275-6325
Practice Address - Street 1:410 FERRY ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-1571
Practice Address - Country:US
Practice Address - Phone:570-275-6325
Practice Address - Fax:570-275-6325
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-003443-L111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAHO194871Medicare ID - Type Unspecified