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General NPI Number Information
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NPI Number | 1316253131
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Entity Type | Organization
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Legal Business Name | TOTAL WELLNESS CTR OF PHILADELPHIA LLC
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Dates
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Enumeration Date | 08/31/2010
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Last Update Date | 08/31/2010
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Provider Practice Location Address
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Address Line | 201 S CAMAC ST
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City | PHILADELPHIA
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State | PA
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Zip | 19107
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Country | US
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Telephone | 215-545-2021
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Fax |
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Provider Business Mailing Address
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Address Line | 201 S CAMAC ST
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City | PHILADELPHIA
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State | PA
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Zip | 19107-5477
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Country | US
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Telephone | 215-545-2021
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. KATHARINE E RUSCHAK
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Credential |
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Telephone | 740-795-4417
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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 | DC005401L
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License Number State | PA
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