=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376880591
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRI-COUNTY CHIROPRACTIC OF EXTON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2013
-----------------------------------------------------
Last Update Date | 01/08/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 312 E LINCOLN HWY
-----------------------------------------------------
City | EXTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19341-2729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-879-6968
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1954 E HIGH ST
-----------------------------------------------------
City | POTTSTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19464-9209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-327-8090
-----------------------------------------------------
Fax | 610-327-0970
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. CHRISTINE SINNOTT TREACY
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 610-327-8090
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------