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General NPI Number Information
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NPI Number | 1184102105
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Entity Type | Organization
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Legal Business Name | EXPERIENCE CHIROPRACTIC EAST, LLC
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Dates
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Enumeration Date | 08/01/2018
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Last Update Date | 08/01/2018
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Provider Practice Location Address
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Address Line | 3038 BUTLER PIKE
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City | CONSHOHOCKEN
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State | PA
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Zip | 19428
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Country | US
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Telephone | 610-337-7463
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Fax |
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Provider Business Mailing Address
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Address Line | 3038 BUTLER PIKE
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City | CONSHOHOCKEN
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State | PA
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Zip | 19428-2115
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Country | US
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Telephone | 610-337-7463
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Fax |
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MAURIE CARROLL
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Credential |
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Telephone | 610-337-7463
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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 | PA
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