Provider Demographics
NPI:1013103993
Name:BROAD AXE CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:BROAD AXE CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WINANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-540-0776
Mailing Address - Street 1:914 SKIPPACK PIKE
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-1535
Mailing Address - Country:US
Mailing Address - Phone:215-540-0776
Mailing Address - Fax:215-570-9022
Practice Address - Street 1:914 SKIPPACK PIKE
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1535
Practice Address - Country:US
Practice Address - Phone:215-540-0776
Practice Address - Fax:215-570-9022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003375L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA504037Medicare PIN
PA504030Medicare PIN