Provider Demographics
NPI:1932168960
Name:CENTRE PARK CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:CENTRE PARK CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HEARING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-375-9319
Mailing Address - Street 1:600 CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601-2827
Mailing Address - Country:US
Mailing Address - Phone:610-375-9319
Mailing Address - Fax:610-375-0356
Practice Address - Street 1:600 CENTRE AVE
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-2827
Practice Address - Country:US
Practice Address - Phone:610-375-9319
Practice Address - Fax:610-375-0356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006631L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA084259Medicare ID - Type UnspecifiedMEDICARE