Provider Demographics
NPI:1144403866
Name:NEW HANOVER CHIROPRACTIC REHABILITATION CENTER PC
Entity Type:Organization
Organization Name:NEW HANOVER CHIROPRACTIC REHABILITATION CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:HALTEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-327-3363
Mailing Address - Street 1:1810 SWAMP PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GILBERTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19525-9307
Mailing Address - Country:US
Mailing Address - Phone:610-327-3363
Mailing Address - Fax:610-327-9829
Practice Address - Street 1:1810 SWAMP PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:GILBERTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19525-9307
Practice Address - Country:US
Practice Address - Phone:610-327-3363
Practice Address - Fax:610-327-9829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003620L111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA037982Medicare PIN