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General NPI Number Information
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NPI Number | 1699903005
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Entity Type | Organization
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Legal Business Name | PASSYUNK CHIROPRACTIC & REHABILITATION
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Dates
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Enumeration Date | 06/24/2009
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Last Update Date | 06/24/2009
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Provider Practice Location Address
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Address Line | 1509 E PASSYUNK AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19147-6322
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Country | US
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Telephone | 215-467-1143
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Fax | 215-467-1599
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Provider Business Mailing Address
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Address Line | PO BOX 22705
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City | PHILADELPHIA
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State | PA
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Zip | 19110-2705
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Country | US
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Telephone | 215-579-7374
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Fax | 215-579-4622
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MICHAEL 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 | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | DC007852L
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License Number State | PA
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