Provider Demographics
NPI:1376635805
Name:BE TRANSFORMED CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:BE TRANSFORMED CHIROPRACTIC, INC
Other - Org Name:HEALTHSOURCE OF ABINGTON
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:BARNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-659-7345
Mailing Address - Street 1:2609 JENKINTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-2501
Mailing Address - Country:US
Mailing Address - Phone:215-659-7345
Mailing Address - Fax:215-780-1221
Practice Address - Street 1:2609 JENKINTOWN RD
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-2501
Practice Address - Country:US
Practice Address - Phone:215-659-7345
Practice Address - Fax:215-780-1221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-004904-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2123264000OtherINDEPENDENCE BLUE CROSS
PA1438519OtherHIGHMARK BLUE SHIELD
PA30003901Medicaid
PA1438519OtherHIGHMARK BLUE SHIELD
PA069407Medicare PIN
PA2123264000OtherINDEPENDENCE BLUE CROSS