Provider Demographics
NPI:1083835284
Name:PROGRESSIVE HEALTH CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:PROGRESSIVE HEALTH CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:NAST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-695-0065
Mailing Address - Street 1:235 LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:FRAZER
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1876
Mailing Address - Country:US
Mailing Address - Phone:610-695-0065
Mailing Address - Fax:610-695-0221
Practice Address - Street 1:235 LANCASTER AVE
Practice Address - Street 2:SUITE F5
Practice Address - City:FRAZER
Practice Address - State:PA
Practice Address - Zip Code:19355-1876
Practice Address - Country:US
Practice Address - Phone:610-695-0065
Practice Address - Fax:610-695-0221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009415111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1851422208OtherNPI TYPE ONE
PAV04440Medicare UPIN
PA089525Medicare ID - Type Unspecified