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General NPI Number Information
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NPI Number | 1003631128
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Entity Type | Organization
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Legal Business Name | ACTIVE CARE MANAYUNK
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Dates
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Enumeration Date | 11/22/2024
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 4368 CRESSON ST
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City | PHILADELPHIA
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State | PA
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Zip | 19127-1460
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Country | US
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Telephone | 215-617-9719
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Fax | 215-827-5606
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Provider Business Mailing Address
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Address Line | 414 RANDALL RD
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City | WYNCOTE
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State | PA
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Zip | 19095-2106
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Country | US
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Telephone | 610-216-3277
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Fax | 215-827-5606
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Authorized Official
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Title or Position | MANAGER
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Name | MAYA WILSON
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Credential |
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Telephone | 215-595-3946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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