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General NPI Number Information
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NPI Number | 1407623200
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Entity Type | Organization
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Legal Business Name | KEYSTONE SPINE AND SPORT LLC
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Dates
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Enumeration Date | 12/11/2023
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 170 N HENDERSON RD STE 310
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-2155
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Country | US
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Telephone | 610-466-5718
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Fax |
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Provider Business Mailing Address
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Address Line | 170 N HENDERSON RD
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-2155
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIMOTHY LEGATH
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Credential | DC
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Telephone | 610-597-3936
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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 |
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