Provider Demographics
NPI:1336429083
Name:INNOVATIVE MUSCLE THERAPY AND PAIN CENTER LLC
Entity Type:Organization
Organization Name:INNOVATIVE MUSCLE THERAPY AND PAIN CENTER LLC
Other - Org Name:INNOVATIVE MUSCLE THERAPY AND PAIN CNTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:484-999-8142
Mailing Address - Street 1:1646 W CHESTER PIKE STE 20
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-7979
Mailing Address - Country:US
Mailing Address - Phone:484-999-8142
Mailing Address - Fax:610-485-7320
Practice Address - Street 1:3100 DUTTON MILL RD
Practice Address - Street 2:
Practice Address - City:ASTON
Practice Address - State:PA
Practice Address - Zip Code:19014-2844
Practice Address - Country:US
Practice Address - Phone:610-485-5001
Practice Address - Fax:610-485-7320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-26
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009088111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty