Provider Demographics
NPI:1649504986
Name:CHESTER PAIN MANAGEMENT
Entity type:Organization
Organization Name:CHESTER PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARRED
Authorized Official - Middle Name:
Authorized Official - Last Name:TELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-478-6159
Mailing Address - Street 1:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020
Mailing Address - Country:US
Mailing Address - Phone:215-478-6159
Mailing Address - Fax:267-212-0020
Practice Address - Street 1:4610 PENNELL ROAD
Practice Address - Street 2:
Practice Address - City:ASTON
Practice Address - State:PA
Practice Address - Zip Code:19014
Practice Address - Country:US
Practice Address - Phone:610-497-3722
Practice Address - Fax:267-212-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty