Provider Demographics
NPI:1477603561
Name:MIDDLETOWN CHIROPRACTIC HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:MIDDLETOWN CHIROPRACTIC HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:VITO
Authorized Official - Last Name:TELESCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-741-0700
Mailing Address - Street 1:380 MIDDLETOWN BLVD
Mailing Address - Street 2:SUITE 706
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1845
Mailing Address - Country:US
Mailing Address - Phone:215-741-0700
Mailing Address - Fax:215-750-2661
Practice Address - Street 1:380 MIDDLETOWN BLVD
Practice Address - Street 2:SUITE 706
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1845
Practice Address - Country:US
Practice Address - Phone:215-741-0700
Practice Address - Fax:215-750-2661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003310L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031455OtherKEYSTONE MERCY
PA2418390000OtherBLUE CROSS
PA4523147OtherAETNA
PA4692772OtherCIGNA
PA4692772OtherUNITED HEALTH CARE
PA01077440-01OtherAMERICHOICE
PAMI1751025OtherBLUE SHIELD
PATE046104Medicare ID - Type Unspecified