Provider Demographics
NPI:1578747721
Name:POCONO CHIROPRACTIC HEALTH CENTRE PC
Entity Type:Organization
Organization Name:POCONO CHIROPRACTIC HEALTH CENTRE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FREY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-424-6782
Mailing Address - Street 1:402 W MOORESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-9569
Mailing Address - Country:US
Mailing Address - Phone:610-759-1300
Mailing Address - Fax:610-759-4418
Practice Address - Street 1:402 W MOORESTOWN RD
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-9569
Practice Address - Country:US
Practice Address - Phone:610-759-1300
Practice Address - Fax:610-759-4418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001460L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA20017664OtherAMERI HEALTH MERCY
PA076225Other1ST PRIORITY HEALTH
PA1015862OtherAETNA HMO
PA179559OtherHIGHMARK
PA290919500OtherCAPITAL BC
PA5802644OtherGHI
PA0010759730007Medicaid
PA4604774OtherAETNA
PA607155OtherUNITED HEALTHCARE
PA179559H32Medicare PIN