Provider Demographics
NPI:1710259809
Name:GENTLE HEALTH & WELLNESS CENTER
Entity Type:Organization
Organization Name:GENTLE HEALTH & WELLNESS CENTER
Other - Org Name:GENTLE HEALTH & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL MONTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MSA
Authorized Official - Phone:267-281-4231
Mailing Address - Street 1:PO BOX 1648
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-6248
Mailing Address - Country:US
Mailing Address - Phone:267-281-4231
Mailing Address - Fax:
Practice Address - Street 1:1601 WALNUT ST STE 809
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-2905
Practice Address - Country:US
Practice Address - Phone:267-281-4231
Practice Address - Fax:267-330-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010070111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA238227Medicare UPIN