1851423784 NPI number — EAGLE CHIROPRACTIC AT POTTSTOWN

Table of content: (NPI 1851423784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851423784 NPI number — EAGLE CHIROPRACTIC AT POTTSTOWN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAGLE CHIROPRACTIC AT POTTSTOWN
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:
1851423784
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2091 POTTSTOWN PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POTTSTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19465-8671
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-469-0700
Provider Business Mailing Address Fax Number:
610-469-8502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2091 POTTSTOWN PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POTTSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19465-8671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-469-0700
Provider Business Practice Location Address Fax Number:
610-469-8502
Provider Enumeration Date:
03/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GOTTLIEB
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
610-469-0700

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC004743L , 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: 673170 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5931123 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 00139115004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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