Provider Demographics
NPI:1891251294
Name:CHIROPRACTIC WELLNESS AND REHABILITATION CLINIC LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC WELLNESS AND REHABILITATION CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:AURAND
Authorized Official - Last Name:SWONGUER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-299-1539
Mailing Address - Street 1:100 E CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:RIDLEY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19078-1703
Mailing Address - Country:US
Mailing Address - Phone:610-532-3401
Mailing Address - Fax:610-532-3403
Practice Address - Street 1:2235 GARRETT RD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-1101
Practice Address - Country:US
Practice Address - Phone:610-626-4180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty