Provider Demographics
NPI:1316067366
Name:RHAWNHURST CHIROPRACTIC
Entity type:Organization
Organization Name:RHAWNHURST CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:D
Authorized Official - Last Name:IZZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-745-7500
Mailing Address - Street 1:7713 CASTOR AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-3601
Mailing Address - Country:US
Mailing Address - Phone:215-745-7500
Mailing Address - Fax:215-745-6842
Practice Address - Street 1:7713 CASTOR AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3601
Practice Address - Country:US
Practice Address - Phone:215-745-7500
Practice Address - Fax:215-745-6842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-001651-L111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2076207000OtherIBC GROUP ID
PA0061006000OtherKEYSTONE IND.
PA042795RYVMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER ID