Provider Demographics
NPI:1558527879
Name:BOYERTOWN CHIROPRACTIC GROUP, PC
Entity Type:Organization
Organization Name:BOYERTOWN CHIROPRACTIC GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROTHENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:BS, DC, FACO, FICC
Authorized Official - Phone:610-367-8161
Mailing Address - Street 1:PO BOX 385
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOYERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19512-0385
Mailing Address - Country:US
Mailing Address - Phone:610-367-8161
Mailing Address - Fax:610-367-9400
Practice Address - Street 1:5TH & MONTGOMERY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BOYERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19512-0385
Practice Address - Country:US
Practice Address - Phone:610-367-8161
Practice Address - Fax:610-367-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-001228-L111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT28965Medicare UPIN