Provider Demographics
NPI:1982801916
Name:BROOMALL MEDICAL GROUP, PC
Entity type:Organization
Organization Name:BROOMALL MEDICAL GROUP, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:RIGHTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-353-2221
Mailing Address - Street 1:2633 W CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-1930
Mailing Address - Country:US
Mailing Address - Phone:610-353-2221
Mailing Address - Fax:610-353-7062
Practice Address - Street 1:2633 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-1930
Practice Address - Country:US
Practice Address - Phone:610-353-2221
Practice Address - Fax:610-353-7062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003758L111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty