Provider Demographics
NPI:1275731069
Name:BACK & NECK CLINIC OF EXETER
Entity Type:Organization
Organization Name:BACK & NECK CLINIC OF EXETER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-404-4442
Mailing Address - Street 1:160 SUNSET MANOR DR
Mailing Address - Street 2:
Mailing Address - City:BIRDSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19508-1018
Mailing Address - Country:US
Mailing Address - Phone:610-404-4442
Mailing Address - Fax:610-404-1057
Practice Address - Street 1:160 SUNSET MANOR DR
Practice Address - Street 2:
Practice Address - City:BIRDSBORO
Practice Address - State:PA
Practice Address - Zip Code:19508-1018
Practice Address - Country:US
Practice Address - Phone:610-404-4442
Practice Address - Fax:610-404-1057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005606L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU49296Medicare UPIN