Provider Demographics
NPI:1093863789
Name:HEALTHSOURCE OF BETHLEHEM LLC
Entity Type:Organization
Organization Name:HEALTHSOURCE OF BETHLEHEM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HURON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:484-282-1633
Mailing Address - Street 1:3864 COURTNEY ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-8987
Mailing Address - Country:US
Mailing Address - Phone:484-282-1644
Mailing Address - Fax:
Practice Address - Street 1:3864 COURTNEY ST
Practice Address - Street 2:SUITE 150
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-8987
Practice Address - Country:US
Practice Address - Phone:484-282-1644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005305L111N00000X
PAAJ005305L111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU60926Medicare UPIN
PA837241Medicare ID - Type UnspecifiedMEDICARE