Provider Demographics
NPI:1912218363
Name:COMPLETE CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:COMPLETE CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-948-4902
Mailing Address - Street 1:830 CHESTNUT ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-2160
Mailing Address - Country:US
Mailing Address - Phone:610-948-4902
Mailing Address - Fax:610-948-4982
Practice Address - Street 1:830 CHESTNUT ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ROYERSFORD
Practice Address - State:PA
Practice Address - Zip Code:19468-2160
Practice Address - Country:US
Practice Address - Phone:610-948-4902
Practice Address - Fax:610-948-4982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007702L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU75192Medicare UPIN