Provider Demographics
NPI:1124318803
Name:DEKALB CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:DEKALB CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:S
Authorized Official - Last Name:ABDALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-272-4181
Mailing Address - Street 1:106 DEKALB ST
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:BRIDGEPORT
Mailing Address - State:PA
Mailing Address - Zip Code:19405-1056
Mailing Address - Country:US
Mailing Address - Phone:610-272-4181
Mailing Address - Fax:610-272-5313
Practice Address - Street 1:106 DEKALB ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:BRIDGEPORT
Practice Address - State:PA
Practice Address - Zip Code:19405-1056
Practice Address - Country:US
Practice Address - Phone:610-272-4181
Practice Address - Fax:610-272-5313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005203L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty