Provider Demographics
NPI:1538307053
Name:KING OF PRUSSIA CHIROPRACTIC AND REHABILITATION
Entity Type:Organization
Organization Name:KING OF PRUSSIA CHIROPRACTIC AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:HEVERIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-579-7374
Mailing Address - Street 1:2041 APPLETREE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1409
Mailing Address - Country:US
Mailing Address - Phone:610-265-2301
Mailing Address - Fax:610-265-2302
Practice Address - Street 1:217 W CHURCH RD
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-3231
Practice Address - Country:US
Practice Address - Phone:610-265-2301
Practice Address - Fax:610-265-2302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1407905144OtherNPI