Provider Demographics
NPI:1710016621
Name:CORRECTIVE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CORRECTIVE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:DURR
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:610-518-3370
Mailing Address - Street 1:797 E LANCASTER AVE
Mailing Address - Street 2:SUITE 7 CORRECTIVE CHIROPRACTIC LLC
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335
Mailing Address - Country:US
Mailing Address - Phone:610-518-3370
Mailing Address - Fax:610-518-3371
Practice Address - Street 1:797 E LANCASTER AVE
Practice Address - Street 2:SUITE 7 CORRECTIVE CHIROPRACTIC LLC
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335
Practice Address - Country:US
Practice Address - Phone:610-518-3370
Practice Address - Fax:610-518-3371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007245L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0423307000OtherBCBS