Provider Demographics
NPI:1366985913
Name:CLASSIC CHIROPRACTIC LLC
Entity type:Organization
Organization Name:CLASSIC CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:KOCHANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-675-7788
Mailing Address - Street 1:77 YORK RD
Mailing Address - Street 2:
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-4501
Mailing Address - Country:US
Mailing Address - Phone:215-675-7788
Mailing Address - Fax:215-675-7792
Practice Address - Street 1:77 YORK RD
Practice Address - Street 2:
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-4501
Practice Address - Country:US
Practice Address - Phone:215-675-7788
Practice Address - Fax:215-675-7792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA009600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty