Provider Demographics
NPI:1902851736
Name:PERSSONAL HEALTH CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:PERSSONAL HEALTH CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:PERSSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-532-3401
Mailing Address - Street 1:100 E CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:RIDLEY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19078-1703
Mailing Address - Country:US
Mailing Address - Phone:610-532-3401
Mailing Address - Fax:610-532-3403
Practice Address - Street 1:100 E CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:RIDLEY PARK
Practice Address - State:PA
Practice Address - Zip Code:19078-1703
Practice Address - Country:US
Practice Address - Phone:610-532-3401
Practice Address - Fax:610-532-3403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA099151Medicare ID - Type Unspecified
PAZ08621Medicare UPIN
PA099151Medicare PIN