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General NPI Number Information
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NPI Number | 1932697406
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Entity Type | Organization
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Legal Business Name | ELKINS PARK CHIROPRACTIC CENTER LLC
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Dates
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Enumeration Date | 04/30/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 1831 W. CHELTENHAM AVE
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City | ELKINS PARK
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State | PA
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Zip | 19027
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Country | US
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Telephone | 267-331-6556
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Fax | 267-335-5336
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Provider Business Mailing Address
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Address Line | 1831 W CHELTENHAM AVE
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City | ELKINS PARK
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State | PA
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Zip | 19027-1049
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Country | US
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Telephone | 267-331-6556
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Fax | 267-335-5336
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEAN HAROLD FONTAINE
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Credential | CHIROPRACTOR
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Telephone | 484-319-2165
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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 |
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License Number State |
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