1730239260 NPI number — CAMAC CHIROPRACTIC AND WELLNESS CENTER L.L.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730239260 NPI number — CAMAC CHIROPRACTIC AND WELLNESS CENTER L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAMAC CHIROPRACTIC AND WELLNESS CENTER L.L.C.
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:
1730239260
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:
1214 MOORE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19148-1516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-271-0318
Provider Business Mailing Address Fax Number:
215-271-0319

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1214 MOORE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19148-1516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-271-0318
Provider Business Practice Location Address Fax Number:
215-271-0319
Provider Enumeration Date:
01/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SBARRA
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
LOUIS
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
215-271-0318

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC007573L , 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: 2295674000 . This is a "BLUE CROSS HMO GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0662915000 . This is a "BLUE CROSS INDIVIDUAL HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7472242 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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