Provider Demographics
NPI:1013134014
Name:COTTAGE FAMILY CHIROPRACTIC CENTER, P.C.
Entity Type:Organization
Organization Name:COTTAGE FAMILY CHIROPRACTIC CENTER, P.C.
Other - Org Name:THRIVE CHIROPRACTIC STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:JODI
Authorized Official - Middle Name:HALPIN
Authorized Official - Last Name:PARSONS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-925-2572
Mailing Address - Street 1:946 LAKE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:AVONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19311-9394
Mailing Address - Country:US
Mailing Address - Phone:610-925-2572
Mailing Address - Fax:610-925-2623
Practice Address - Street 1:946 LAKE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:AVONDALE
Practice Address - State:PA
Practice Address - Zip Code:19311-9394
Practice Address - Country:US
Practice Address - Phone:610-925-2572
Practice Address - Fax:610-925-2623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009675111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA117987Medicare UPIN