Provider Demographics
NPI:1558406488
Name:AMIN, KETAN HARSHAD (DC,BCAO)
Entity Type:Individual
Prefix:DR
First Name:KETAN
Middle Name:HARSHAD
Last Name:AMIN
Suffix:
Gender:M
Credentials:DC,BCAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-4307
Mailing Address - Country:US
Mailing Address - Phone:215-368-9915
Mailing Address - Fax:215-368-4988
Practice Address - Street 1:223 HARTMAN BRIDGE RD
Practice Address - Street 2:
Practice Address - City:RONKS
Practice Address - State:PA
Practice Address - Zip Code:17572-9793
Practice Address - Country:US
Practice Address - Phone:717-687-0809
Practice Address - Fax:215-368-4988
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005993L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor