1518987023 NPI number — PROFESSIONAL FAMILY CHIROPRACTIC, INC.

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 1518987023 NPI number — PROFESSIONAL FAMILY CHIROPRACTIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROFESSIONAL FAMILY CHIROPRACTIC, INC.
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:
1518987023
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
296 HOFFMANSVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BECHTELSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19505-9517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-754-6577
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
296 HOFFMANSVILLE RAOD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SASSAMANSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-754-6577
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GIORDANO
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
610-754-6577

Provider Taxonomy Codes

  • Taxonomy code: 111NN1001X , with the licence number:  DC-004999L , 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: 2852135 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5040006 . This is a "AETNA NON-HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0684152000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5002582 . This is a "CAPITOL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PR507287 . This is a "HIGHMARK/ BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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