Provider Demographics
NPI:1356494090
Name:ADELPHIA CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:ADELPHIA CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-295-9550
Mailing Address - Street 1:636 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:FAIRLESS HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19030-1416
Mailing Address - Country:US
Mailing Address - Phone:215-295-9550
Mailing Address - Fax:215-295-9393
Practice Address - Street 1:636 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:FAIRLESS HILLS
Practice Address - State:PA
Practice Address - Zip Code:19030-1416
Practice Address - Country:US
Practice Address - Phone:215-295-9550
Practice Address - Fax:215-295-9393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-003555-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000432546OtherHIGHMARK BS GRP#
PA0310182000OtherBCBS GRP#
PAU24835Medicare UPIN
PA0310182000OtherBCBS GRP#