Provider Demographics
NPI:1235319674
Name:ALDEN BRIDGE CHIROPRATIC CENTER PA
Entity Type:Organization
Organization Name:ALDEN BRIDGE CHIROPRATIC CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CIANCIULLI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:281-367-8101
Mailing Address - Street 1:25802 INTERSTATE 45
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-1032
Mailing Address - Country:US
Mailing Address - Phone:281-367-8101
Mailing Address - Fax:281-367-8209
Practice Address - Street 1:25802 INTERSTATE 45
Practice Address - Street 2:SUITE A
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-1032
Practice Address - Country:US
Practice Address - Phone:281-367-8101
Practice Address - Fax:281-367-8209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6976111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0010HDOtherBLUE CROSS BLUE SHIELD
TXDF2635OtherMEDICARE RR
TXDF2635OtherMEDICARE RR