Provider Demographics
NPI:1922061803
Name:KOMAREK CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:KOMAREK CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:KALLELIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:215-321-4481
Mailing Address - Street 1:1313 LORD STERLING RD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:WASHINGTON CROSSING
Mailing Address - State:PA
Mailing Address - Zip Code:18977-1345
Mailing Address - Country:US
Mailing Address - Phone:215-321-4481
Mailing Address - Fax:215-321-4482
Practice Address - Street 1:1313 LORD STERLING RD
Practice Address - Street 2:SUITE #2
Practice Address - City:WASHINGTON CROSSING
Practice Address - State:PA
Practice Address - Zip Code:18977-1345
Practice Address - Country:US
Practice Address - Phone:215-321-4481
Practice Address - Fax:215-321-4482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-007450L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty