Healthcare Provider Details

I. General information

NPI: 1376590281
Provider Name (Legal Business Name): WEATHERVANE CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 BUSTLETON PIKE
CHURCHVILLE PA
18966-1508
US

IV. Provider business mailing address

120 BUSTLETON PIKE
CHURCHVILLE PA
18966-1508
US

V. Phone/Fax

Practice location:
  • Phone: 215-322-1300
  • Fax: 215-322-5301
Mailing address:
  • Phone: 215-322-1300
  • Fax: 215-322-5301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. HOWARD AARON BLOOM
Title or Position: PRESIDENT
Credential: D.C., C.C.E.P.
Phone: 215-322-1300