Healthcare Provider Details

I. General information

NPI: 1144403866
Provider Name (Legal Business Name): NEW HANOVER CHIROPRACTIC REHABILITATION CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 SWAMP PIKE SUITE 100
GILBERTSVILLE PA
19525-9307
US

IV. Provider business mailing address

1810 SWAMP PIKE SUITE 100
GILBERTSVILLE PA
19525-9307
US

V. Phone/Fax

Practice location:
  • Phone: 610-327-3363
  • Fax: 610-327-9829
Mailing address:
  • Phone: 610-327-3363
  • Fax: 610-327-9829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC003620L
License Number StatePA

VIII. Authorized Official

Name: DR. MARK L. HALTEMAN
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 610-327-3363