Provider Demographics
NPI:1780613448
Name:DR STUART K HIMMELSTEIN DC PC
Entity type:Organization
Organization Name:DR STUART K HIMMELSTEIN DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:HIMMELSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-632-3074
Mailing Address - Street 1:PO BOX 321
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-0321
Mailing Address - Country:US
Mailing Address - Phone:215-632-3074
Mailing Address - Fax:
Practice Address - Street 1:3392 RED LION RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114
Practice Address - Country:US
Practice Address - Phone:215-632-3074
Practice Address - Fax:215-672-3373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006032L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U55842Medicare UPIN
PA821395Medicare ID - Type Unspecified