Provider Demographics
NPI:1720380983
Name:CHIROPRACTIC REHABILITATION & WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC REHABILITATION & WELLNESS CENTER, LLC
Other - Org Name:PERSSONAL HEALTH CHIROPRACTIC & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:AURAND
Authorized Official - Last Name:SWONGUER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:267-324-3156
Mailing Address - Street 1:3370 MEMPHIS ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-4510
Mailing Address - Country:US
Mailing Address - Phone:267-324-3156
Mailing Address - Fax:267-324-3195
Practice Address - Street 1:3370 MEMPHIS ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4510
Practice Address - Country:US
Practice Address - Phone:267-324-3156
Practice Address - Fax:267-324-3195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-21
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty