Healthcare Provider Details

I. General information

NPI: 1275666232
Provider Name (Legal Business Name): LEHIGH VALLEY SPINAL CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4450 W MOUNTAIN VIEW DR
WALNUTPORT PA
18088-9429
US

IV. Provider business mailing address

4450 W MOUNTAIN VIEW DR
WALNUTPORT PA
18088-9429
US

V. Phone/Fax

Practice location:
  • Phone: 610-767-8888
  • Fax: 610-760-8965
Mailing address:
  • Phone: 610-767-8888
  • Fax: 610-760-8965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC007463L
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier1659390128
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerINDIVIDUAL NPI
# 2
Identifier01734709
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: DR. ROSS BUCHIERI
Title or Position: OWNER
Credential: DC
Phone: 610-760-8888