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General NPI Number Information
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NPI Number | 1982801916
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Entity Type | Organization
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Legal Business Name | BROOMALL MEDICAL GROUP, PC
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Dates
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Enumeration Date | 07/02/2007
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Last Update Date | 07/13/2007
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Provider Practice Location Address
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Address Line | 2633 W CHESTER PIKE
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City | BROOMALL
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State | PA
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Zip | 19008-1930
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Country | US
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Telephone | 610-353-2221
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Fax | 610-353-7062
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Provider Business Mailing Address
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Address Line | 2633 W CHESTER PIKE
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City | BROOMALL
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State | PA
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Zip | 19008-1930
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Country | US
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Telephone | 610-353-2221
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Fax | 610-353-7062
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Authorized Official
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Title or Position | MANAGER
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Name | MS. JENNIFER RIGHTLEY
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Credential |
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Telephone | 610-353-2221
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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 | DC003758L
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License Number State | PA
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