Healthcare Provider Details

I. General information

NPI: 1902175706
Provider Name (Legal Business Name): NORTH WHITEHALL CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3315 MAUCH CHUNK RD
COPLAY PA
18037-2074
US

IV. Provider business mailing address

3315 MAUCH CHUNK RD
COPLAY PA
18037-2074
US

V. Phone/Fax

Practice location:
  • Phone: 610-769-7700
  • Fax:
Mailing address:
  • Phone: 610-769-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC010360
License Number StatePA

VIII. Authorized Official

Name: DR. DAVID JASON ROY
Title or Position: PRESIDENT/ CHIROPRACTOR
Credential: D.C.
Phone: 610-769-7700