=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043339583
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY CHIROPRACTIC & REHABILITATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2007
-----------------------------------------------------
Last Update Date | 02/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 515 W CHELTEN AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19144-4414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-457-7246
-----------------------------------------------------
Fax | 856-489-4481
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1878 MARLTON PIKE E SUITE 2
-----------------------------------------------------
City | CHERRY HILL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08003-2090
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-489-4480
-----------------------------------------------------
Fax | 856-489-4481
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MICHAEL GREENBERG
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 215-457-7246
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | AJ007539L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC008755
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | AJ008755
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC007539L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------