Provider Demographics
NPI:1912562455
Name:HEALTHBRIDGE WYNNEWOOD LLC
Entity Type:Organization
Organization Name:HEALTHBRIDGE WYNNEWOOD LLC
Other - Org Name:HEALTHBRIDGE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:STATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-782-3891
Mailing Address - Street 1:PO BOX 8918
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-8918
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:THE LANKENAU MEDICAL OFFICE BUILDING -EAST
Practice Address - Street 2:100 LANCASTER AVENUE SUITE 353
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3433
Practice Address - Country:US
Practice Address - Phone:610-228-2820
Practice Address - Fax:610-228-2218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty