Provider Demographics
NPI:1326088758
Name:KING OF PRUSSIA FAMILY WELLNESS CENTER, PC
Entity Type:Organization
Organization Name:KING OF PRUSSIA FAMILY WELLNESS CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEMCHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-337-7463
Mailing Address - Street 1:992 OLD EAGLE SCHOOL RD
Mailing Address - Street 2:SUITE 902
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-1803
Mailing Address - Country:US
Mailing Address - Phone:610-337-7463
Mailing Address - Fax:
Practice Address - Street 1:992 OLD EAGLE SCHOOL RD
Practice Address - Street 2:SUITE 902
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-1803
Practice Address - Country:US
Practice Address - Phone:610-337-7463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KING OF PRUSSIA FAMILY WELLNESS CENTER, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-07
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1326088758Medicare PIN