Provider Demographics
NPI:1447793559
Name:IMPACT CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:IMPACT CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:484-200-7711
Mailing Address - Street 1:187 W LINCOLN HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2617
Mailing Address - Country:US
Mailing Address - Phone:484-200-7711
Mailing Address - Fax:610-706-4889
Practice Address - Street 1:187 W LINCOLN HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2617
Practice Address - Country:US
Practice Address - Phone:484-200-7711
Practice Address - Fax:610-706-4889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011153111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty