Provider Demographics
NPI:1720330137
Name:REALM CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:REALM CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:DEEUGENIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-305-8611
Mailing Address - Street 1:36 BUCKY RUN LANE
Mailing Address - Street 2:
Mailing Address - City:THORNHURST
Mailing Address - State:PA
Mailing Address - Zip Code:18424
Mailing Address - Country:US
Mailing Address - Phone:856-305-8611
Mailing Address - Fax:856-854-4504
Practice Address - Street 1:73 MONTAGE MOUNTAIN ROAD
Practice Address - Street 2:SUITE 3
Practice Address - City:MOOSIC
Practice Address - State:PA
Practice Address - Zip Code:18507
Practice Address - Country:US
Practice Address - Phone:570-800-7991
Practice Address - Fax:570-909-9285
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REALM CHIROPRACTIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-09
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00687100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty