Provider Demographics
NPI:1003016817
Name:EXTON HEALTH SMART SPINAL CENTER PC
Entity Type:Organization
Organization Name:EXTON HEALTH SMART SPINAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZEIGLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-524-7417
Mailing Address - Street 1:313 E LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341
Mailing Address - Country:US
Mailing Address - Phone:610-524-7417
Mailing Address - Fax:610-524-7418
Practice Address - Street 1:313 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341
Practice Address - Country:US
Practice Address - Phone:610-524-7417
Practice Address - Fax:610-524-7418
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXTON HEALTH SMART SPINAL CENTER PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007092L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAM01798985Medicaid
PAM01798985Medicaid