Healthcare Provider Details

I. General information

NPI: 1801004387
Provider Name (Legal Business Name): TERESA C GOHEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 DEEP RUN ROAD SUITE D
PIPERSVILLE PA
18947
US

IV. Provider business mailing address

PO BOX 204
PIPERSVILLE PA
18947-0204
US

V. Phone/Fax

Practice location:
  • Phone: 215-766-3073
  • Fax: 215-766-3075
Mailing address:
  • Phone: 215-766-3073
  • Fax: 215-766-3075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: TERESA C GOHEN
Title or Position: OWNER
Credential: DC
Phone: 215-766-3073