Provider Demographics
NPI:1982810271
Name:RESNICK CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:RESNICK CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:RESNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-363-7625
Mailing Address - Street 1:305 N POTTSTOWN PIKE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2242
Mailing Address - Country:US
Mailing Address - Phone:610-363-7625
Mailing Address - Fax:
Practice Address - Street 1:305 N POTTSTOWN PIKE
Practice Address - Street 2:SUITE 206
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2242
Practice Address - Country:US
Practice Address - Phone:610-363-7625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARE690221Medicare ID - Type Unspecified