Provider Demographics
NPI:1043339583
Name:CITY CHIROPRACTIC & REHABILITATION
Entity Type:Organization
Organization Name:CITY CHIROPRACTIC & REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-457-7246
Mailing Address - Street 1:1878 MARLTON PIKE E
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2090
Mailing Address - Country:US
Mailing Address - Phone:856-489-4480
Mailing Address - Fax:856-489-4481
Practice Address - Street 1:515 W CHELTEN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-4414
Practice Address - Country:US
Practice Address - Phone:215-457-7246
Practice Address - Fax:856-489-4481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007539L111N00000X
PAAJ007539L111N00000X
PADC008755111N00000X
PAAJ008755111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022116150001Medicaid