Provider Demographics
NPI:1982761185
Name:NISSLEY FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:NISSLEY FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NISSLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:717-656-8000
Mailing Address - Street 1:34 KEYSTONE CT
Mailing Address - Street 2:
Mailing Address - City:LEOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17540-2207
Mailing Address - Country:US
Mailing Address - Phone:717-656-8000
Mailing Address - Fax:717-656-8080
Practice Address - Street 1:34 KEYSTONE CT
Practice Address - Street 2:
Practice Address - City:LEOLA
Practice Address - State:PA
Practice Address - Zip Code:17540-2207
Practice Address - Country:US
Practice Address - Phone:717-656-8000
Practice Address - Fax:717-656-8080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007379L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA059220Medicare ID - Type Unspecified