1548464688 NPI number — ALPHA CHIROPRACTIC

Table of content: (NPI 1548464688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548464688 NPI number — ALPHA CHIROPRACTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALPHA CHIROPRACTIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548464688
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2027 LORRAINE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
READING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19604-1420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-334-5417
Provider Business Mailing Address Fax Number:
610-373-4636

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
336 S 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
READING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19602-2404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-334-5417
Provider Business Practice Location Address Fax Number:
610-373-4636
Provider Enumeration Date:
06/13/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GIPSON
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
CLAY
Authorized Official Title or Position:
VICE-PRESIDENT
Authorized Official Telephone Number:
610-334-5417

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC005000L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)