Provider Demographics
NPI:1790898336
Name:ALLEGHENY FAMILY CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:ALLEGHENY FAMILY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:J
Authorized Official - Last Name:KENT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-425-1110
Mailing Address - Street 1:2514 E ALLEGHENY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-5102
Mailing Address - Country:US
Mailing Address - Phone:215-425-1110
Mailing Address - Fax:215-425-5610
Practice Address - Street 1:2514 E ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-5102
Practice Address - Country:US
Practice Address - Phone:215-425-1110
Practice Address - Fax:215-425-5610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002404L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008745180002Medicaid
PA0008745180002Medicaid
AL099458Medicare ID - Type Unspecified