MEDICARE: CHESTNUT HILL CHIROPRACTIC PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC-007036	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306807276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHESTNUT HILL CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	8618 GERMANTOWN AVE
Second Line	:	1ST FLOOR REAR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-2841
Country	:	US
Telephone Number	:	215-248-5460
Fax Number	:

Provider Business Practice Location Address
First Line	:	8618 GERMANTOWN AVE
Second Line	:	1ST FLOOR REAR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-2841
Country	:	US
Telephone Number	:	215-248-5460
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. AUSTIN J NOONAN
Credential	:	DC
Telephone Number	:	215-248-5460

Provider Enumeration Date	:	03/30/2006
Last Update Date	:	09/26/2013

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