Provider Demographics
NPI:1124097290
Name:ALLENTOWN CHIROPRACTIC CENTER PC
Entity type:Organization
Organization Name:ALLENTOWN CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:KULIK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-791-1020
Mailing Address - Street 1:1850 E EMMAUS AVENUE
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-4422
Mailing Address - Country:US
Mailing Address - Phone:610-791-1020
Mailing Address - Fax:610-791-9691
Practice Address - Street 1:1850 E EMMAUS AVENUE
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-4422
Practice Address - Country:US
Practice Address - Phone:610-791-1020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001414L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
02562200OtherCAPITAL BLUE CROSS
AL1327482OtherHIGHMARK BLUE SHIELD
PA0006361960001Medicaid
055222Medicare ID - Type Unspecified
T29140Medicare UPIN
055222Medicare PIN