MEDICARE: KING OF PRUSSIA FAMILY WELLNESS CENTER, 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

General Provider Information

NPI Number	:	1326088758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KING OF PRUSSIA FAMILY WELLNESS CENTER, PC

Provider Business Mailing Address
First Line	:	992 OLD EAGLE SCHOOL RD
Second Line	:	SUITE 902
City	:	WAYNE
State	:	PA
Zip	:	19087-1803
Country	:	US
Telephone Number	:	610-337-7463
Fax Number	:

Provider Business Practice Location Address
First Line	:	992 OLD EAGLE SCHOOL RD
Second Line	:	SUITE 902
City	:	WAYNE
State	:	PA
Zip	:	19087-1803
Country	:	US
Telephone Number	:	610-337-7463
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	DR. BRANDIE NEMCHENKO
Credential	:	DC
Telephone Number	:	610-337-7463

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	03/01/2016

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