Provider Demographics
NPI:1538372933
Name:FIRST DC HOLISTIC MEDICAL CENTRE
Entity type:Organization
Organization Name:FIRST DC HOLISTIC MEDICAL CENTRE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:LAVANGA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-364-1112
Mailing Address - Street 1:112 E PENNSYLVANIA BLVD
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-7843
Mailing Address - Country:US
Mailing Address - Phone:215-364-1112
Mailing Address - Fax:215-364-3231
Practice Address - Street 1:112 E PENNSYLVANIA BLVD
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-7843
Practice Address - Country:US
Practice Address - Phone:215-364-1112
Practice Address - Fax:215-364-3231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003377L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1038026OtherASHN
PA2823869OtherAETNA
PA5017555OtherAETNA
PACAQHOtherCAQH
PA663095OtherACN GROUP
PAN90763OtherAMERIHEALTH
PA1390763OtherHIGHMARK BLUESHEILD
PA381023OtherMAMSI
PA4924929OtherCIGNA
PA2080174000OtherPERSONAL CHOICE KEYSTONE
PA3685273OtherAETNA
PA740993OtherFIRST HEALTH
PAT30687Medicare UPIN
PA381023OtherMAMSI