Provider Demographics
NPI:1699729897
Name:EASTERN PA. CHIROPRACTIC AND FUNCTIONAL REHAB
Entity type:Organization
Organization Name:EASTERN PA. CHIROPRACTIC AND FUNCTIONAL REHAB
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:W
Authorized Official - Last Name:WEISMANTEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-536-4333
Mailing Address - Street 1:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:OTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18942-0497
Mailing Address - Country:US
Mailing Address - Phone:215-536-4333
Mailing Address - Fax:215-536-5030
Practice Address - Street 1:312 JUNIPER ST
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1604
Practice Address - Country:US
Practice Address - Phone:215-536-4333
Practice Address - Fax:215-536-5030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC8644111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA664536OtherACN GROUP
PA001546577OtherHIGHMARK BCBS
PA2230857000OtherPERSONAL CHOICE
PA3325817OtherAETNA
PA2230857000OtherKEYSTONE AMERIHEALTH
PA3325817OtherAETNA
PA2230857000OtherPERSONAL CHOICE