Provider Demographics
NPI:1831310200
Name:CHAMBERLAIN CHIROPRACTIC INC
Entity Type:Organization
Organization Name:CHAMBERLAIN CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHAMBERLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-429-4920
Mailing Address - Street 1:1223 W CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-5686
Mailing Address - Country:US
Mailing Address - Phone:610-429-4920
Mailing Address - Fax:
Practice Address - Street 1:1223 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-5686
Practice Address - Country:US
Practice Address - Phone:610-429-4920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004938L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1412495OtherHIGHMARK
PA2102996000OtherKEYSTONE
PA076161Medicare ID - Type Unspecified
PA1412495OtherHIGHMARK