Organization Active NPI

Legacy Wellness & Chiropractic

  • Chiropractor
  • Harrisburg, PA
National Provider Identifier
1104285055
Registry record updated Feb 24, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
DC010958 Issued in PA
Legal business name
LEGACY WELLNESS & CHIROPRACTIC
Practice address
2209 Forest Hills Dr
Suite 22
Harrisburg, PA 17112-1095
Phone
(717) 657-1620
NPI assigned
Feb 21, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Marlaina Carson, D.C.NPI 1992102867
Title
Owner
Phone
(570) 916-6332

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X DC010958 PA Primary

Addresses

Primary practice location

2209 Forest Hills Dr
Suite 22
Harrisburg, PA 17112-1095

Mailing address

2209 Forest Hills Dr
Ste 22
Harrisburg, PA 17112-1095

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170224000036 PA Part B Supplier - Clinic/Group Practice 2365726064 Receives reassigned benefits from 1 practitioner
Practice locations: Harrisburg, PA

National Provider Directory

National Provider Directory

Locations

2209 Forest Hills Dr
Ste 22
Harrisburg, PA 17112
Phone (717) 657-1620

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1456012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487894400000",
    "number": "1104285055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2209 FOREST HILLS DR",
            "address_2": "STE 22",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171121095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2209 FOREST HILLS DR",
            "address_2": "SUITE 22",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171121095",
            "telephone_number": "717-657-1620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY WELLNESS & CHIROPRACTIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-21",
        "last_updated": "2017-02-24",
        "status": "A",
        "authorized_official_last_name": "CARSON",
        "authorized_official_first_name": "MARLAINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "570-916-6332",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "DC010958",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Harrisburg, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.