MEDICARE: ABSOLUTE CHIROPRACTIC

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	111NR0400X	Rehabilitation Chiropractor
2	111N00000X	Chiropractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2363551000	OTHER	PA	INDEPENDENCE BC GROUP ID

General Provider Information

NPI Number	:	1699805937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABSOLUTE CHIROPRACTIC

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

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

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	MR. JASON N. WEIGNER
Credential	:	D.C.
Telephone Number	:	610-876-6180

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	10/27/2021

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Directions to “ABSOLUTE CHIROPRACTIC ” Practice Location

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