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General NPI Number Information
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NPI Number | 1003889536
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Entity Type | Organization
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Legal Business Name | S. EAGLE RD CHIROPRACTIC INC
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Dates
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Enumeration Date | 02/07/2006
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Last Update Date | 07/30/2007
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Provider Practice Location Address
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Address Line | 31 S. EAGLE RD SUITE 101
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City | HAVERTOWN
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State | PA
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Zip | 19083
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Country | US
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Telephone | 610-789-7669
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Fax | 610-789-7672
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Provider Business Mailing Address
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Address Line | 31 S. EAGLE RD SUITE 101
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City | HAVERTOWN
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State | PA
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Zip | 19083
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Country | US
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Telephone | 610-789-7669
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Fax | 610-789-7672
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Authorized Official
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Title or Position | OWNER DOCTOR
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Name | DR. LAURA BAILEY
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Credential | DC
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Telephone | 610-789-7669
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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 | DC-004701-L
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License Number State | PA
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