Provider Demographics
NPI:1770501926
Name:LAND CHIROPRACTIC PC
Entity Type:Organization
Organization Name:LAND CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:K
Authorized Official - Last Name:LAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-643-0700
Mailing Address - Street 1:617 N BETHLEHEM PIKE
Mailing Address - Street 2:SUITE C
Mailing Address - City:LOWER GWYNEDD
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2507
Mailing Address - Country:US
Mailing Address - Phone:215-643-0700
Mailing Address - Fax:215-643-0119
Practice Address - Street 1:617 N BETHLEHEM PIKE
Practice Address - Street 2:SUITE C
Practice Address - City:LOWER GWYNEDD
Practice Address - State:PA
Practice Address - Zip Code:19002-2507
Practice Address - Country:US
Practice Address - Phone:215-643-0700
Practice Address - Fax:215-643-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007625L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2346977000OtherIBC GROUP
PA3741136OtherAETNA GROUP
PALA1671476OtherHIGHMARK GROUP