Healthcare Provider Details

I. General information

NPI: 1407375132
Provider Name (Legal Business Name): ADAM WALDHORN MSAOM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MORGAN HWY STE 4
SCRANTON PA
18508-2641
US

IV. Provider business mailing address

6379 SHERWOOD RD
PHILADELPHIA PA
19151-2521
US

V. Phone/Fax

Practice location:
  • Phone: 570-344-3788
  • Fax: 570-969-9280
Mailing address:
  • Phone: 310-927-6259
  • Fax: 310-927-6259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAK001219
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: