Provider Demographics
NPI:1124419767
Name:SPINAL CARE CHIROPRACTIC AND JOINT REHABILITATION, P.C.
Entity type:Organization
Organization Name:SPINAL CARE CHIROPRACTIC AND JOINT REHABILITATION, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOS
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-562-1269
Mailing Address - Street 1:109 SECOND AVE
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2608
Mailing Address - Country:US
Mailing Address - Phone:386-562-1269
Mailing Address - Fax:610-489-8821
Practice Address - Street 1:109 SECOND AVE
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-2608
Practice Address - Country:US
Practice Address - Phone:386-562-1269
Practice Address - Fax:610-489-8821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009896111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty