Provider Demographics
NPI:1568533131
Name:NORTHEAST PAIN MANAGEMENT CENTER P C
Entity Type:Organization
Organization Name:NORTHEAST PAIN MANAGEMENT CENTER P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:V
Authorized Official - Last Name:EASAW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-934-6665
Mailing Address - Street 1:10184 VERREE RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-3637
Mailing Address - Country:US
Mailing Address - Phone:215-934-6665
Mailing Address - Fax:215-934-5151
Practice Address - Street 1:10184 VERREE RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-3637
Practice Address - Country:US
Practice Address - Phone:215-934-6665
Practice Address - Fax:215-934-5151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty