Healthcare Provider Details

I. General information

NPI: 1225041411
Provider Name (Legal Business Name): NORTHEAST CHIROPRACTIC ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 ACADEMY RD SUITE 102
PHILADELPHIA PA
19114-1120
US

IV. Provider business mailing address

10101 ACADEMY RD SUITE 102
PHILADELPHIA PA
19114-1120
US

V. Phone/Fax

Practice location:
  • Phone: 215-824-1000
  • Fax: 215-824-4460
Mailing address:
  • Phone: 215-824-1000
  • Fax: 215-824-4460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-002985-L
License Number StatePA

VIII. Authorized Official

Name: DR. JAMIL M ZAID
Title or Position: PRESIDENT
Credential: D.C.
Phone: 215-824-1000