Provider Demographics
NPI:1356495741
Name:DESARO CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:DESARO CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:K
Authorized Official - Last Name:DESARO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-364-6636
Mailing Address - Street 1:95 ALMSHOUSE RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:RICHBORO
Mailing Address - State:PA
Mailing Address - Zip Code:18954
Mailing Address - Country:US
Mailing Address - Phone:215-364-6636
Mailing Address - Fax:215-364-5482
Practice Address - Street 1:95 ALMSHOUSE RD
Practice Address - Street 2:SUITE 304
Practice Address - City:RICHBORO
Practice Address - State:PA
Practice Address - Zip Code:18954
Practice Address - Country:US
Practice Address - Phone:215-364-6636
Practice Address - Fax:215-364-5482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007390L111N00000X
PADC007391L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty