Provider Demographics
NPI:1811131659
Name:BROAD STREET CHIRPORACTIC, INC
Entity type:Organization
Organization Name:BROAD STREET CHIRPORACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:E
Authorized Official - Last Name:OZANNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-536-2225
Mailing Address - Street 1:1226 W. BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-1230
Mailing Address - Country:US
Mailing Address - Phone:215-536-2225
Mailing Address - Fax:215-536-6516
Practice Address - Street 1:1226 W. BROAD STREET
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1230
Practice Address - Country:US
Practice Address - Phone:215-536-2225
Practice Address - Fax:215-536-6516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty