Provider Demographics
NPI:1316117187
Name:CENTER CITY CHIROPRACTIC & REHABILITATION
Entity type:Organization
Organization Name:CENTER CITY CHIROPRACTIC & REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:C
Authorized Official - Last Name:HARDING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-764-0528
Mailing Address - Street 1:2041 APPLETREE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1409
Mailing Address - Country:US
Mailing Address - Phone:215-557-9090
Mailing Address - Fax:215-557-9089
Practice Address - Street 1:1425 ARCH ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1528
Practice Address - Country:US
Practice Address - Phone:215-557-9090
Practice Address - Fax:215-557-9089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008941111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2685106000OtherIBC GROUP NUMBER