Provider Demographics
NPI:1093469397
Name:HEALTHSOURCE CHIROPRACTIC OF NEW PRAGUE, PA
Entity Type:Organization
Organization Name:HEALTHSOURCE CHIROPRACTIC OF NEW PRAGUE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:575-760-9207
Mailing Address - Street 1:314 MAIN ST E
Mailing Address - Street 2:
Mailing Address - City:NEW PRAGUE
Mailing Address - State:MN
Mailing Address - Zip Code:56071-2448
Mailing Address - Country:US
Mailing Address - Phone:952-758-4121
Mailing Address - Fax:
Practice Address - Street 1:314 MAIN ST E
Practice Address - Street 2:
Practice Address - City:NEW PRAGUE
Practice Address - State:MN
Practice Address - Zip Code:56071-2448
Practice Address - Country:US
Practice Address - Phone:952-758-4121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty