Provider Demographics
NPI:1932697406
Name:ELKINS PARK CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:ELKINS PARK CHIROPRACTIC CENTER LLC
Other - Org Name:ELKINS PARK CHIROPRACTIC CENTER LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:FONTAINE
Authorized Official - Suffix:
Authorized Official - Credentials:CHIROPRACTOR
Authorized Official - Phone:484-319-2165
Mailing Address - Street 1:1831 W CHELTENHAM AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1049
Mailing Address - Country:US
Mailing Address - Phone:267-331-6556
Mailing Address - Fax:267-335-5336
Practice Address - Street 1:1831 W. CHELTENHAM AVE
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027
Practice Address - Country:US
Practice Address - Phone:267-331-6556
Practice Address - Fax:267-335-5336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-30
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty