Provider Demographics
NPI:1558573774
Name:FAMILY CHIROPRACTIC WELLNESS CENTER
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:LAKERNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-534-4776
Mailing Address - Street 1:625 CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:PROSPECT PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19076
Mailing Address - Country:US
Mailing Address - Phone:610-534-4776
Mailing Address - Fax:610-534-7245
Practice Address - Street 1:625 CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:PROSPECT PARK
Practice Address - State:PA
Practice Address - Zip Code:19076
Practice Address - Country:US
Practice Address - Phone:610-534-4776
Practice Address - Fax:610-534-7245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004519L111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty