Provider Demographics
NPI:1063466993
Name:KESSLER CHIROPRACTIC CENTER, LLC
Entity Type:Organization
Organization Name:KESSLER CHIROPRACTIC CENTER, LLC
Other - Org Name:ROBERT N. KESSLER, D.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:N
Authorized Official - Last Name:KESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-698-5800
Mailing Address - Street 1:9987 VERREE RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-1437
Mailing Address - Country:US
Mailing Address - Phone:215-698-5800
Mailing Address - Fax:215-698-0998
Practice Address - Street 1:9987 VERREE RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-1437
Practice Address - Country:US
Practice Address - Phone:215-698-5800
Practice Address - Fax:215-698-0998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003582L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA22277010000OtherKEYSTONE HMO ID
PA001539983OtherHIGHMARK BLUE SHIELD ID
PA22277010000OtherKEYSTONE HMO ID
PA541566Medicare ID - Type UnspecifiedMEDICARE