Provider Demographics
NPI:1730239260
Name:CAMAC CHIROPRACTIC AND WELLNESS CENTER L.L.C.
Entity type:Organization
Organization Name:CAMAC CHIROPRACTIC AND WELLNESS CENTER L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:SBARRA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-271-0318
Mailing Address - Street 1:1214 MOORE ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-1516
Mailing Address - Country:US
Mailing Address - Phone:215-271-0318
Mailing Address - Fax:215-271-0319
Practice Address - Street 1:1214 MOORE ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19148-1516
Practice Address - Country:US
Practice Address - Phone:215-271-0318
Practice Address - Fax:215-271-0319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007573L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2295674000OtherBLUE CROSS HMO GROUP
PA0662915000OtherBLUE CROSS INDIVIDUAL HMO
PA7472242OtherAETNA PPO
PA034757SZDMedicare ID - Type UnspecifiedINDIVIDUAL
PA=========Medicare UPIN
PA2295674000OtherBLUE CROSS HMO GROUP