Provider Demographics
NPI:1720378441
Name:AMERICAN BODY CARE, LLC
Entity Type:Organization
Organization Name:AMERICAN BODY CARE, LLC
Other - Org Name:AMERICAN BODY CARE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:NATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-886-3000
Mailing Address - Street 1:1653 THE FAIRWAY
Mailing Address - Street 2:SUITE 214
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-1420
Mailing Address - Country:US
Mailing Address - Phone:215-886-3000
Mailing Address - Fax:215-357-5764
Practice Address - Street 1:1653 THE FAIRWAY
Practice Address - Street 2:SUITE 214
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-1420
Practice Address - Country:US
Practice Address - Phone:215-886-3000
Practice Address - Fax:215-357-5764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2790-L AJ111NS0005X
PA5243208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty