Provider Demographics
NPI:1619342771
Name:TWIN VALLEY UPPER CERVICAL CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:TWIN VALLEY UPPER CERVICAL CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:610-913-1222
Mailing Address - Street 1:319 DARBY SQ
Mailing Address - Street 2:4225 MAIN STREET
Mailing Address - City:ELVERSON
Mailing Address - State:PA
Mailing Address - Zip Code:19520-9302
Mailing Address - Country:US
Mailing Address - Phone:610-913-1222
Mailing Address - Fax:
Practice Address - Street 1:319 DARBY SQ
Practice Address - Street 2:
Practice Address - City:ELVERSON
Practice Address - State:PA
Practice Address - Zip Code:19520-9302
Practice Address - Country:US
Practice Address - Phone:610-913-1222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-01
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC10660111N00000X
PADC010659111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1003963083Medicare PIN
PA1124175112Medicare PIN