=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407114408
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ULTIMATE HEALTH AND CHIROPRACTIC PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2012
-----------------------------------------------------
Last Update Date | 05/07/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 BALA AVE 2 FL
-----------------------------------------------------
City | BALA CYNWYD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19004-3333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-245-3065
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 BALA AVE 2 FL
-----------------------------------------------------
City | BALA CYNWYD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19004-3333
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-245-3065
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ARIEL D GILBERT
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 215-764-9311
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC009887
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------