Provider Demographics
NPI:1396959375
Name:HOMETOWN WELLNESS AND CHIROPRACTIC CENTER LLC
Entity type:Organization
Organization Name:HOMETOWN WELLNESS AND CHIROPRACTIC CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMOIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-566-9575
Mailing Address - Street 1:27 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3348
Mailing Address - Country:US
Mailing Address - Phone:610-566-9575
Mailing Address - Fax:610-566-9570
Practice Address - Street 1:27 W STATE ST
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3348
Practice Address - Country:US
Practice Address - Phone:610-566-9575
Practice Address - Fax:610-566-9570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2015-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007302111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA007698Medicare ID - Type UnspecifiedMEDICARE GROUP ID