Provider Demographics
NPI:1548914476
Name:BROAD WELLNESS AND CHIROPRACTIC CENTER, P.C.
Entity type:Organization
Organization Name:BROAD WELLNESS AND CHIROPRACTIC CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALASDAIR
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-322-6360
Mailing Address - Street 1:1248 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19121-5100
Mailing Address - Country:US
Mailing Address - Phone:267-239-0092
Mailing Address - Fax:
Practice Address - Street 1:1248 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-5100
Practice Address - Country:US
Practice Address - Phone:267-239-0092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-09
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty