Provider Demographics
NPI:1942410170
Name:DR. O. FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:DR. O. FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:O'LOUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-514-6686
Mailing Address - Street 1:211 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3019
Mailing Address - Country:US
Mailing Address - Phone:215-514-6686
Mailing Address - Fax:610-565-8493
Practice Address - Street 1:319 PRITCHARD LN
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:PA
Practice Address - Zip Code:19086-6104
Practice Address - Country:US
Practice Address - Phone:215-514-6686
Practice Address - Fax:610-565-8493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008761111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2134360000OtherINDEPENDENCE BLUE CROSS
PA001451301OtherHIGHMARK BLUE SHIELD
PA001451301OtherHIGHMARK BLUE SHIELD