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General NPI Number Information
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NPI Number | 1679865547
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Entity Type | Organization
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Legal Business Name | KING OF PRUSSIA CHIROPRACTIC&HOLISTIC WELLNESS CENTER LLC
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Dates
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Enumeration Date | 05/10/2011
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Last Update Date | 01/17/2012
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Provider Practice Location Address
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Address Line | 860 FIRST AVE SUITE 1
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-4033
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Country | US
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Telephone | 610-265-2522
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Fax |
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Provider Business Mailing Address
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Address Line | 860 FIRST AVE SUITE 1
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-4033
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Country | US
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Telephone | 610-265-2522
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. WENDI GIBSON
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Credential | D.C.
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Telephone | 610-265-2522
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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 | DC003324L
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License Number State | PA
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