Provider Demographics
NPI:1699805937
Name:ABSOLUTE CHIROPRACTIC
Entity type:Organization
Organization Name:ABSOLUTE CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:N
Authorized Official - Last Name:WEIGNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-876-6180
Mailing Address - Street 1:3605 EDGMONT AVE.
Mailing Address - Street 2:BLDG A
Mailing Address - City:BROOKHAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:19015
Mailing Address - Country:US
Mailing Address - Phone:610-876-6180
Mailing Address - Fax:610-876-6130
Practice Address - Street 1:3605 EDGMONT AVE.
Practice Address - Street 2:BLDG A
Practice Address - City:BROOKHAVEN
Practice Address - State:PA
Practice Address - Zip Code:19015
Practice Address - Country:US
Practice Address - Phone:610-876-6180
Practice Address - Fax:610-876-6130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2363551000OtherINDEPENDENCE BC GROUP ID
PA2363551000OtherINDEPENDENCE BC GROUP ID