Provider Demographics
NPI: | 1750447462 |
---|---|
Name: | CHIROPRACTIC MOBILE EXAMINERS, LLC |
Entity Type: | Organization |
Organization Name: | CHIROPRACTIC MOBILE EXAMINERS, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | RUSSELL |
Authorized Official - Middle Name: | THOMAS |
Authorized Official - Last Name: | MONTALBANO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 484-256-4832 |
Mailing Address - Street 1: | 2804 2ND ST |
Mailing Address - Street 2: | |
Mailing Address - City: | TROOPER |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 19403-1503 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 484-256-4832 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 311 W JOHNSON HWY UNIT 6A |
Practice Address - Street 2: | |
Practice Address - City: | NORRISTOWN |
Practice Address - State: | PA |
Practice Address - Zip Code: | 19401-1992 |
Practice Address - Country: | US |
Practice Address - Phone: | 484-256-4832 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-12-28 |
Last Update Date: | 2020-04-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | DC007912L | 111N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Single Specialty |