=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164837712
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PINE RUN ALTERNATIVE HEALTH CARE CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2014
-----------------------------------------------------
Last Update Date | 06/23/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 455 EASTON RD
-----------------------------------------------------
City | HORSHAM
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19044-2508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-956-0322
-----------------------------------------------------
Fax | 215-957-8788
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 455 EASTON RD
-----------------------------------------------------
City | HORSHAM
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19044-2508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-956-0322
-----------------------------------------------------
Fax | 215-957-8788
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JOHN SINNOTT
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 215-956-0322
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC003551L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------