Provider Demographics
NPI:1043265184
Name:CHIROPRACTIC CENTER AT BODY CRAFTERS, LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC CENTER AT BODY CRAFTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCHAKJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-464-6922
Mailing Address - Street 1:9251 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-2205
Mailing Address - Country:US
Mailing Address - Phone:215-464-6922
Mailing Address - Fax:215-464-6923
Practice Address - Street 1:9251 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2205
Practice Address - Country:US
Practice Address - Phone:215-464-6922
Practice Address - Fax:215-464-6923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009102111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA088360Medicare ID - Type Unspecified
PAU98801Medicare UPIN