Provider Demographics
NPI:1619019940
Name:ASSURED HEALTH CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:ASSURED HEALTH CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ELLSWORTH
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:610-565-9426
Mailing Address - Street 1:1020 N PROVIDENCE ROAD
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063
Mailing Address - Country:US
Mailing Address - Phone:610-565-9426
Mailing Address - Fax:610-565-8982
Practice Address - Street 1:1020 N PROVIDENCE ROAD
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063
Practice Address - Country:US
Practice Address - Phone:610-565-9426
Practice Address - Fax:610-565-8982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005118L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAAS1763917OtherBLUE SHIELD HIGHMARK GR
PA703722Medicare PIN
0539304000Medicare UPIN