Provider Demographics
NPI:1801004387
Name:TERESA C GOHEN
Entity Type:Organization
Organization Name:TERESA C GOHEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:C
Authorized Official - Last Name:GOHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-766-3073
Mailing Address - Street 1:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:PIPERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18947-0204
Mailing Address - Country:US
Mailing Address - Phone:215-766-3073
Mailing Address - Fax:215-766-3075
Practice Address - Street 1:1806 DEEP RUN ROAD
Practice Address - Street 2:SUITE D
Practice Address - City:PIPERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18947
Practice Address - Country:US
Practice Address - Phone:215-766-3073
Practice Address - Fax:215-766-3075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2278875000OtherINDEPENDENCE BLUE CROSS
PA068616Medicare ID - Type Unspecified