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General NPI Number Information
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NPI Number | 1609061654
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Entity Type | Organization
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Legal Business Name | ATHLETIC EDGE CHIROPRACTIC & REHABILITATION LLC
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Dates
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Enumeration Date | 09/12/2007
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Last Update Date | 01/03/2014
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Provider Practice Location Address
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Address Line | 1982 BUTLER PIKE SUITE #2
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City | CONSHOHOCKEN
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State | PA
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Zip | 19428-3701
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Country | US
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Telephone | 610-940-6756
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Fax | 610-940-6797
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Provider Business Mailing Address
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Address Line | 1982 BUTLER PIKE SUITE #2
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City | CONSHOHOCKEN
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State | PA
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Zip | 19428-3701
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Country | US
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Telephone | 610-940-6756
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Fax | 610-940-6797
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Authorized Official
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Title or Position | OWNER
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Name | DR. HEATHER NICOLE GOLDBERG
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Credential | DC
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Telephone | 610-940-6756
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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 | DC009828
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License Number State | PA
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