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General NPI Number Information
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NPI Number | 1649505264
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Entity Type | Organization
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Legal Business Name | EBENEZER UPPER CERVICAL CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 10/15/2009
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Last Update Date | 04/18/2011
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Provider Practice Location Address
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Address Line | 300 N POTTSTOWN PIKE SUITE 280
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City | EXTON
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State | PA
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Zip | 19341
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Country | US
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Telephone | 484-879-6053
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Fax |
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Provider Business Mailing Address
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Address Line | 300 N POTTSTOWN PIKE SUITE 280
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City | EXTON
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State | PA
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Zip | 19341
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Country | US
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Telephone | 484-879-6053
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. BRYAN FYE ZYN CHOONG
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Credential | D.C.
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Telephone | 484-879-6053
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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 | DC010060
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License Number State | PA
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