Provider Demographics
NPI: | 1619478310 |
---|---|
Name: | SAMSEL INTEGRATIVE HEALTH LLC |
Entity type: | Organization |
Organization Name: | SAMSEL INTEGRATIVE HEALTH LLC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | KATIE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SAMSEL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 215-944-8424 |
Mailing Address - Street 1: | 305 CORPORATE DR E |
Mailing Address - Street 2: | |
Mailing Address - City: | LANGHORNE |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 19047-8009 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 215-944-8424 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 305 CORPORATE DR E |
Practice Address - Street 2: | |
Practice Address - City: | LANGHORNE |
Practice Address - State: | PA |
Practice Address - Zip Code: | 19047-8009 |
Practice Address - Country: | US |
Practice Address - Phone: | 215-944-8424 |
Practice Address - Fax: | 267-364-5286 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-02-27 |
Last Update Date: | 2018-02-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | DC010400 | 111N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Single Specialty |