Provider Demographics
NPI:1164814059
Name:WILLOW GROVE GET WELL
Entity Type:Organization
Organization Name:WILLOW GROVE GET WELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUARNACCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-366-7363
Mailing Address - Street 1:612 FITZWATERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1904
Mailing Address - Country:US
Mailing Address - Phone:215-366-7363
Mailing Address - Fax:215-366-7393
Practice Address - Street 1:612 FITZWATERTOWN RD
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1904
Practice Address - Country:US
Practice Address - Phone:215-366-7363
Practice Address - Fax:215-366-7393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006600Y111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty