Provider Demographics
NPI:1417222183
Name:OVATION CHIROPRACTIC & WELLNESS CENTER
Entity Type:Organization
Organization Name:OVATION CHIROPRACTIC & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RON
Authorized Official - Middle Name:G
Authorized Official - Last Name:SISCOE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-646-6400
Mailing Address - Street 1:1825 LIMEKILN PIKE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:DRESHER
Mailing Address - State:PA
Mailing Address - Zip Code:19025-1739
Mailing Address - Country:US
Mailing Address - Phone:215-646-6400
Mailing Address - Fax:
Practice Address - Street 1:1825 LIMEKILN PIKE
Practice Address - Street 2:SUITE 5
Practice Address - City:DRESHER
Practice Address - State:PA
Practice Address - Zip Code:19025-1739
Practice Address - Country:US
Practice Address - Phone:215-646-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007499L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
270105Medicare PIN