Healthcare Provider Details

I. General information

NPI: 1699805937
Provider Name (Legal Business Name): ABSOLUTE CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 EDGMONT AVE. BLDG A
BROOKHAVEN PA
19015
US

IV. Provider business mailing address

3605 EDGMONT AVE. BLDG A
BROOKHAVEN PA
19015
US

V. Phone/Fax

Practice location:
  • Phone: 610-876-6180
  • Fax: 610-876-6130
Mailing address:
  • Phone: 610-876-6180
  • Fax: 610-876-6130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

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