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General NPI Number Information
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NPI Number | 1023056454
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Entity Type | Organization
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Legal Business Name | CHRONIC CONDITION RECOVERY CENTER, INC
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 06/30/2016
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Provider Practice Location Address
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Address Line | 17 REGENCY PLZ
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City | GLEN MILLS
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State | PA
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Zip | 19342-1000
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Country | US
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Telephone | 610-558-8920
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Fax |
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Provider Business Mailing Address
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Address Line | 17 REGENCY PLZ
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City | GLEN MILLS
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State | PA
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Zip | 19342-1000
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Country | US
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Telephone | 610-558-8920
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | ERIC S BALCAVAGE
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Credential | DC
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Telephone | 610-558-8920
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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 | AJ006290L
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License Number State | PA
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