Provider Demographics
NPI:1538125125
Name:ASHTON VILLAGE CHIROPRACTIC HEALTH CENTER INC
Entity Type:Organization
Organization Name:ASHTON VILLAGE CHIROPRACTIC HEALTH CENTER INC
Other - Org Name:SMITH CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC CCSP
Authorized Official - Phone:215-673-1113
Mailing Address - Street 1:2875 HOLME AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152
Mailing Address - Country:US
Mailing Address - Phone:215-673-1113
Mailing Address - Fax:215-673-4941
Practice Address - Street 1:2875 HOLME AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152
Practice Address - Country:US
Practice Address - Phone:215-673-1113
Practice Address - Fax:215-673-4941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003171L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1514680Medicaid
PA3539605000OtherBLUE CROSS/BLUE SHIELD
PA897911OtherAETNA
T28603Medicare UPIN
PA897911OtherAETNA