Provider Demographics
NPI:1306807276
Name:CHESTNUT HILL CHIROPRACTIC PC
Entity type:Organization
Organization Name:CHESTNUT HILL CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:NOONAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-248-5460
Mailing Address - Street 1:8618 GERMANTOWN AVE
Mailing Address - Street 2:1ST FLOOR REAR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-2841
Mailing Address - Country:US
Mailing Address - Phone:215-248-5460
Mailing Address - Fax:
Practice Address - Street 1:8618 GERMANTOWN AVE
Practice Address - Street 2:1ST FLOOR REAR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-2841
Practice Address - Country:US
Practice Address - Phone:215-248-5460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-30
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-007036111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01968539Medicaid
PA01968539Medicaid