Provider Demographics
NPI:1982726030
Name:WASSERKRUG CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:WASSERKRUG CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:WASSERKRUG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-345-8141
Mailing Address - Street 1:204 N WEST ST
Mailing Address - Street 2:STE 105
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-3507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:204 N WEST ST
Practice Address - Street 2:STE 105
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-3507
Practice Address - Country:US
Practice Address - Phone:215-345-8141
Practice Address - Fax:215-345-8173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007758L PA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2678925000OtherKEYSTONE HEALTH PLAN EAST
PA1821171OtherPERSONAL CHOICE BLUECROSS
PAS21171OtherAMERIHEALTH ADMINISTRATOR
PA2678925000OtherINDEPENDENCE BLUECROSS
PA1821171OtherHIGHMARK BLUECROSS
PA1821171OtherHIGHMARK BLUECROSS
PA2678925000OtherKEYSTONE HEALTH PLAN EAST