Susquehanna Spine & Joint Center

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC009656 Issued in PA

Legal business name

SUSQUEHANNA SPINE & JOINT CENTER

Practice address

46 S 18TH St
Columbia, PA 17512-9595

Phone

(717) 681-0198

Fax

(717) 681-0198

NPI assigned

Feb 16, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Blake Keith Staker, D.C.NPI 1790791580

Title

Chiropractor

Phone

(717) 681-0198

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 1

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

• Blake Keith Staker, D.C.

  • Chiropractor
  • Columbia, PA
  • NPI 1790791580
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1424044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429056000000",
    "number": "1679964332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46 S 18TH ST",
            "city": "COLUMBIA",
            "state": "PA",
            "postal_code": "175129595",
            "telephone_number": "717-681-0198",
            "fax_number": "717-681-0198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46 S 18TH ST",
            "city": "COLUMBIA",
            "state": "PA",
            "postal_code": "175129595",
            "telephone_number": "717-681-0198",
            "fax_number": "717-681-0198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSQUEHANNA SPINE & JOINT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-16",
        "last_updated": "2015-04-15",
        "status": "A",
        "authorized_official_last_name": "STAKER",
        "authorized_official_first_name": "BLAKE",
        "authorized_official_middle_name": "KEITH",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "717-681-0198",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "DC009656",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101651583",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Blake Keith Staker, D.C.
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• Susquehanna Rehabilitation & Wellness Center LLC
• Susquehanna Valley Nursing and Rehabilitation Center LLC
• T W Ponessa and Associates Counseling Services Inc
• T. W. Ponessa and Associates Counseling Services, Inc.
• T.W. Ponessa and Associates Counseling Services, Inc.
• The Robert M. Lombard Hyperbaric Oxygenation Medical Center

• All providers in Columbia, PA
• Chiropractor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2015; 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.