Healthcare Provider Details

I. General information

NPI: 1578358024
Provider Name (Legal Business Name): CHIROPRACTIC HEALTH AND PAIN INSTITUTE PA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 LINCOLN HWY
FAIRLESS HILLS PA
19030-1012
US

IV. Provider business mailing address

29040 N SPOON CT
MUNDELEIN IL
60060-5311
US

V. Phone/Fax

Practice location:
  • Phone: 920-256-0392
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TAYLOR MILLER
Title or Position: COO
Credential: DC
Phone: 906-399-5636