1104908235 NPI number — THE CHIROPRACTIC & INJURY CENTER OF LANGHORNE, LLC

Table of content: (NPI 1104908235)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104908235 NPI number — THE CHIROPRACTIC & INJURY CENTER OF LANGHORNE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CHIROPRACTIC & INJURY CENTER OF LANGHORNE, LLC
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:
THE CHIROPRACTIC & INJURY CENTER
Provider Other Organization Name Type Code:
5
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:
1104908235
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1039
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANGHORNE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19047-6039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-547-1998
Provider Business Mailing Address Fax Number:
215-547-3994

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
936 WOODBOURNE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEVITTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19057-1001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-547-1998
Provider Business Practice Location Address Fax Number:
215-547-3994
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FREZZA
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
ARTHUR
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
215-547-1998

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC006617L , 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)

  • Identifier: 1469531 . This is a "HIGHMARK BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2173257000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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