Provider Demographics
NPI: | 1346315983 |
---|---|
Name: | PEAK POTENTIAL WELLNESS CTR INC |
Entity Type: | Organization |
Organization Name: | PEAK POTENTIAL WELLNESS CTR INC |
Other - Org Name: | PEAK POTENTIAL FAMILY CHIROPRACTIC LLC |
Other - Org Type: | Former Legal Business Name |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | BRIAN |
Authorized Official - Middle Name: | ERNEST |
Authorized Official - Last Name: | CAPALDI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 610-240-9010 |
Mailing Address - Street 1: | 1340 SWEDESFORD RD |
Mailing Address - Street 2: | |
Mailing Address - City: | BERWYN |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 19312 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 610-240-9010 |
Mailing Address - Fax: | 610-240-0950 |
Practice Address - Street 1: | 1340 SWEDESFORD RD |
Practice Address - Street 2: | |
Practice Address - City: | BERWYN |
Practice Address - State: | PA |
Practice Address - Zip Code: | 19312 |
Practice Address - Country: | US |
Practice Address - Phone: | 610-240-9010 |
Practice Address - Fax: | 610-240-0950 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-11-21 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Single Specialty |