Provider Demographics
NPI:1649505264
Name:EBENEZER UPPER CERVICAL CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:EBENEZER UPPER CERVICAL CHIROPRACTIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:FYE ZYN
Authorized Official - Last Name:CHOONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:484-879-6053
Mailing Address - Street 1:300 N POTTSTOWN PIKE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341
Mailing Address - Country:US
Mailing Address - Phone:484-879-6053
Mailing Address - Fax:
Practice Address - Street 1:300 N POTTSTOWN PIKE
Practice Address - Street 2:SUITE 280
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341
Practice Address - Country:US
Practice Address - Phone:484-879-6053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010060111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty