1699805937 NPI number — ABSOLUTE CHIROPRACTIC

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 1699805937 NPI number — ABSOLUTE CHIROPRACTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABSOLUTE 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:
6
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:
1699805937
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3605 EDGMONT AVE.
Provider Second Line Business Mailing Address:
BLDG A
Provider Business Mailing Address City Name:
BROOKHAVEN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-876-6180
Provider Business Mailing Address Fax Number:
610-876-6130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3605 EDGMONT AVE.
Provider Second Line Business Practice Location Address:
BLDG A
Provider Business Practice Location Address City Name:
BROOKHAVEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-876-6180
Provider Business Practice Location Address Fax Number:
610-876-6130
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WEIGNER
Authorized Official First Name:
JASON
Authorized Official Middle Name:
N.
Authorized Official Title or Position:
OWNER/CEO
Authorized Official Telephone Number:
610-876-6180

Provider Taxonomy Codes

  • Taxonomy code: 111NR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2363551000 . This is a "INDEPENDENCE BC GROUP ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com