Provider Demographics
NPI:1477932077
Name:HEADACHE RELIEF PA, LLC
Entity Type:Organization
Organization Name:HEADACHE RELIEF PA, LLC
Other - Org Name:THE MIGRAINE HEADACHE RELIEF CENTER OF PENNSYLVANIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SPENCER
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-388-7040
Mailing Address - Street 1:300 OLD FORGE LN
Mailing Address - Street 2:SUITE #303
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-1897
Mailing Address - Country:US
Mailing Address - Phone:610-388-7040
Mailing Address - Fax:610-388-7042
Practice Address - Street 1:300 OLD FORGE LN
Practice Address - Street 2:SUITE #303
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-1897
Practice Address - Country:US
Practice Address - Phone:610-388-7040
Practice Address - Fax:610-388-7042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024622L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty