Provider Demographics
NPI:1558707315
Name:THREE ACES LLC
Entity Type:Organization
Organization Name:THREE ACES LLC
Other - Org Name:4700 CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:S
Authorized Official - Last Name:SOTTILE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-789-5555
Mailing Address - Street 1:4700 TOWNSHIP LINE RD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-4222
Mailing Address - Country:US
Mailing Address - Phone:610-789-5555
Mailing Address - Fax:484-452-6045
Practice Address - Street 1:4700 TOWNSHIP LINE RD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-4222
Practice Address - Country:US
Practice Address - Phone:610-789-5555
Practice Address - Fax:484-452-6045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007180L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty