=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861512147
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELKINS PARK FAMILY CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2007
-----------------------------------------------------
Last Update Date | 09/18/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 699 W GERMANTOWN PIKE STE 400
-----------------------------------------------------
City | PLYMOUTH MEETING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19462-1008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-828-3943
-----------------------------------------------------
Fax | 610-828-3946
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 933 W MAIN ST
-----------------------------------------------------
City | NORRISTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19401-5503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-272-3330
-----------------------------------------------------
Fax | 610-272-7113
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. ERIC B LEVIN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 610-828-3943
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC006090L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------