Provider Demographics
NPI:1144362237
Name:KIMBERTON CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:KIMBERTON CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:SCHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:484-921-4936
Mailing Address - Street 1:1125 W BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-4270
Mailing Address - Country:US
Mailing Address - Phone:484-921-4936
Mailing Address - Fax:610-917-0170
Practice Address - Street 1:1125 W BRIDGE ST
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-4270
Practice Address - Country:US
Practice Address - Phone:484-921-4936
Practice Address - Fax:610-917-0170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005948L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232777873Medicare ID - Type Unspecified
GAP00072016Medicare ID - Type Unspecified
PAU54369Medicare UPIN