Provider Demographics
NPI:1003944802
Name:CORPORATE CHIROPRACTIC
Entity Type:Organization
Organization Name:CORPORATE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:CLIFFORD
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-853-9000
Mailing Address - Street 1:35 W EAGLE RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-2204
Mailing Address - Country:US
Mailing Address - Phone:610-853-9000
Mailing Address - Fax:610-626-4554
Practice Address - Street 1:35 W EAGLE RD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2204
Practice Address - Country:US
Practice Address - Phone:610-853-9000
Practice Address - Fax:610-626-4554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004659L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001780806OtherHIGHMARK BLUE SHIELD
PA1780806OtherINDEPENDENCE BLUE CROSS
PA001780806OtherHIGHMARK BLUE SHIELD