Provider Demographics
NPI:1376761221
Name:STATE LINE HEALTH CARE LLC
Entity Type:Organization
Organization Name:STATE LINE HEALTH CARE LLC
Other - Org Name:STATE LINE HEALTH CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:HILARY
Authorized Official - Last Name:KLOUD
Authorized Official - Suffix:
Authorized Official - Credentials:CHIROPRACTOR
Authorized Official - Phone:302-354-2616
Mailing Address - Street 1:301 WILMINGTON W CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-9048
Mailing Address - Country:US
Mailing Address - Phone:302-354-2616
Mailing Address - Fax:
Practice Address - Street 1:301 WILMINGTON W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:CHADDS FORD
Practice Address - State:PA
Practice Address - Zip Code:19317-9048
Practice Address - Country:US
Practice Address - Phone:610-459-4114
Practice Address - Fax:610-459-2938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001997L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T29475Medicare UPIN
KL136384Medicare ID - Type Unspecified