Provider Demographics
NPI:1205880416
Name:AZZATORI CHIROPRACTIC OF WILLOW GROVE
Entity type:Organization
Organization Name:AZZATORI CHIROPRACTIC OF WILLOW GROVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:YERKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-538-2266
Mailing Address - Street 1:612 FITZWATERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1904
Mailing Address - Country:US
Mailing Address - Phone:215-830-6800
Mailing Address - Fax:215-830-9712
Practice Address - Street 1:612 FITZWATERTOWN RD
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1904
Practice Address - Country:US
Practice Address - Phone:215-830-6800
Practice Address - Fax:215-830-9712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010543111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1527055OtherBC/BS ASSIGNMENT ACCT #
PA2216547000OtherKEYSTONE PROV #