Provider Demographics
NPI:1043397037
Name:AMERICAN CLINIC OF CHIROPRACTIC
Entity Type:Organization
Organization Name:AMERICAN CLINIC OF CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-582-0056
Mailing Address - Street 1:PO BOX 115
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:PA
Mailing Address - Zip Code:19033-0115
Mailing Address - Country:US
Mailing Address - Phone:267-582-0056
Mailing Address - Fax:610-490-3904
Practice Address - Street 1:1 E BEACON LIGHT LN
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-4433
Practice Address - Country:US
Practice Address - Phone:267-582-0056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011570400003Medicaid
PA543793Medicare UPIN