Provider Demographics
NPI:1174578967
Name:GENESIS CHIROPRACTIC CLINIC PC
Entity type:Organization
Organization Name:GENESIS CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GENE
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:FISH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-343-3223
Mailing Address - Street 1:801 COUNTY LINE RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-1403
Mailing Address - Country:US
Mailing Address - Phone:215-343-3223
Mailing Address - Fax:
Practice Address - Street 1:801 COUNTY LINE RD
Practice Address - Street 2:SUITE 6
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044
Practice Address - Country:US
Practice Address - Phone:215-343-3223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA090516Medicare PIN