=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770121451
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAPPY CHIROPRACTIC & WELLNESS CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2019
-----------------------------------------------------
Last Update Date | 03/26/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 704 DEKALB PIKE
-----------------------------------------------------
City | BLUE BELL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19422-1214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-530-3318
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 316 SILO MILL LN
-----------------------------------------------------
City | LANSDALE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19446-5939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-530-3318
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JUN SANG PARK
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 267-530-3318
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------