Provider Demographics
NPI:1033402227
Name:ADVANCED WELLNESS CENTER OF BETHLEHEM
Entity Type:Organization
Organization Name:ADVANCED WELLNESS CENTER OF BETHLEHEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FELICIANO-FLATTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-419-0196
Mailing Address - Street 1:147 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-6219
Mailing Address - Country:US
Mailing Address - Phone:610-419-0196
Mailing Address - Fax:
Practice Address - Street 1:147 E BROAD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6219
Practice Address - Country:US
Practice Address - Phone:610-419-0196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-20
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty