Provider Demographics
NPI:1639218027
Name:K G M B HEALTHWERKS, P.C.
Entity Type:Organization
Organization Name:K G M B HEALTHWERKS, P.C.
Other - Org Name:VALLEY SPORTS AND SPINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WERKHEISER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-746-3332
Mailing Address - Street 1:224 NAZARETH PIKE
Mailing Address - Street 2:SUITE 19
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-9080
Mailing Address - Country:US
Mailing Address - Phone:610-746-3332
Mailing Address - Fax:610-746-3381
Practice Address - Street 1:224 NAZARETH PIKE
Practice Address - Street 2:SUITE 19
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-9080
Practice Address - Country:US
Practice Address - Phone:610-746-3332
Practice Address - Fax:610-746-3381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007931L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50041806OtherCBC PROVIDER#
PA1035366OtherASHN PROVIDER#
PAP3697343OtherOXFORD PROVIDER#
PA001651035OtherBS GROUP PROVIDER#
PA3656918OtherAETNA GROUP PROVIDER#
PA50041806OtherCBC PROVIDER#
PA085725Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER#