Provider Demographics
NPI:1114602901
Name:AZURE STAR CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:AZURE STAR CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INDRANANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ISHAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-893-0866
Mailing Address - Street 1:701 W BROAD ST STE 211
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-5229
Mailing Address - Country:US
Mailing Address - Phone:484-893-0866
Mailing Address - Fax:
Practice Address - Street 1:701 W BROAD ST STE 211
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5229
Practice Address - Country:US
Practice Address - Phone:484-893-0866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty