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General NPI Number Information
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NPI Number | 1538307053
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Entity Type | Organization
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Legal Business Name | KING OF PRUSSIA CHIROPRACTIC AND REHABILITATION
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Dates
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Enumeration Date | 01/22/2009
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Last Update Date | 01/22/2009
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Provider Practice Location Address
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Address Line | 217 W CHURCH RD
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-3231
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Country | US
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Telephone | 610-265-2301
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Fax | 610-265-2302
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Provider Business Mailing Address
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Address Line | 2041 APPLETREE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19103-1409
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Country | US
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Telephone | 610-265-2301
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Fax | 610-265-2302
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Authorized Official
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Title or Position | MANAGER
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Name | MICHAEL D HEVERIN
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Credential |
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Telephone | 215-579-7374
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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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