Provider Demographics
NPI:1104987098
Name:DENISE PRIMAVERA D.C., P.C.
Entity type:Organization
Organization Name:DENISE PRIMAVERA D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PRIMAVERA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-723-7900
Mailing Address - Street 1:4019 BETHLEHEM PIKE
Mailing Address - Street 2:
Mailing Address - City:TELFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18969-1126
Mailing Address - Country:US
Mailing Address - Phone:215-723-7900
Mailing Address - Fax:215-723-4481
Practice Address - Street 1:4019 BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:TELFORD
Practice Address - State:PA
Practice Address - Zip Code:18969-1126
Practice Address - Country:US
Practice Address - Phone:215-723-7900
Practice Address - Fax:215-723-4481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005445L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2012269000OtherIBC PROVIDER ID
PA2696603000OtherKEYSTONE GROUP ID
PA1256503OtherAETNA PROVIDER ID
PAS39676OtherAMERIHEALTH PROVIDER ID
PA1256503OtherAETNA PROVIDER ID