Provider Demographics
NPI:1053486779
Name:JENKINTOWN CHIROPRACTIC CENTER, INC.
Entity Type:Organization
Organization Name:JENKINTOWN CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:B
Authorized Official - Last Name:TOLLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-885-8730
Mailing Address - Street 1:435 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2705
Mailing Address - Country:US
Mailing Address - Phone:215-885-8730
Mailing Address - Fax:215-885-7665
Practice Address - Street 1:435 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2705
Practice Address - Country:US
Practice Address - Phone:215-885-8730
Practice Address - Fax:215-885-7665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004405L261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0004405572OtherAETNA
PA1985023OtherHIGHMARK BLUE SHIELD
PA2795998000OtherKEYSTONE HEATH CARE EAST
PA121055Medicare PIN