Provider Demographics
NPI:1174853147
Name:WEST PHILLY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:WEST PHILLY CHIROPRACTIC, LLC
Other - Org Name:HEALTHBRIDGE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-782-1394
Mailing Address - Street 1:5201 WYNNEFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-2456
Mailing Address - Country:US
Mailing Address - Phone:267-292-9200
Mailing Address - Fax:
Practice Address - Street 1:5201 WYNNEFIELD AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19131-2456
Practice Address - Country:US
Practice Address - Phone:267-292-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004883L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1285748533OtherNPI
PA1386758647OtherNPI
PA1447235288OtherNPI
PA1770697633OtherNPI