Provider Demographics
NPI:1023469996
Name:UPPER BUCKS WELLNESS
Entity type:Organization
Organization Name:UPPER BUCKS WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BLASCO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:215-538-6199
Mailing Address - Street 1:515 S WEST END BLVD
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-1400
Mailing Address - Country:US
Mailing Address - Phone:215-538-6199
Mailing Address - Fax:
Practice Address - Street 1:515 S WEST END BLVD
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1400
Practice Address - Country:US
Practice Address - Phone:215-538-6199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004472L111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty