Provider Demographics
NPI:1952592024
Name:HAVERFORD CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:HAVERFORD CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MYCHLAUK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-687-8280
Mailing Address - Street 1:105 N WAYNE AVE
Mailing Address - Street 2:REAR
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-3566
Mailing Address - Country:US
Mailing Address - Phone:610-687-8280
Mailing Address - Fax:610-687-8103
Practice Address - Street 1:105 N WAYNE AVE
Practice Address - Street 2:REAR
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3566
Practice Address - Country:US
Practice Address - Phone:610-687-8280
Practice Address - Fax:610-687-8103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 002095 L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMY143924Medicare PIN