Provider Demographics
NPI:1598844300
Name:CHIROPRACTIC HEALTH CENTER
Entity type:Organization
Organization Name:CHIROPRACTIC HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-675-3833
Mailing Address - Street 1:3130 MEMORIAL HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-9228
Mailing Address - Country:US
Mailing Address - Phone:570-675-3833
Mailing Address - Fax:570-675-3225
Practice Address - Street 1:3130 MEMORIAL HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-9228
Practice Address - Country:US
Practice Address - Phone:570-675-3833
Practice Address - Fax:570-675-3225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001312L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0619284Medicaid
T28807Medicare UPIN
PA435629Medicare PIN