Provider Demographics
NPI:1467549691
Name:PHOENIX LASER THERAPY & CHIROPRACTIC CENTER, INC.
Entity Type:Organization
Organization Name:PHOENIX LASER THERAPY & CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CORNELL
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:YELLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-265-1124
Mailing Address - Street 1:256 MALL BLVD
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2902
Mailing Address - Country:US
Mailing Address - Phone:610-265-1124
Mailing Address - Fax:610-265-1134
Practice Address - Street 1:256 MALL BLVD
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2902
Practice Address - Country:US
Practice Address - Phone:610-265-1124
Practice Address - Fax:610-265-1134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006347L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty