Basic Information
| Provider Information | |||||||||
| NPI: | 1235575531 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SPINAL WELLNESS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2026 CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191034446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155691900 | ||||||||
| FaxNumber: | 2155692776 | ||||||||
| Practice Location | |||||||||
| Address1: | 2026 CHESTNUT ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191034446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155691900 | ||||||||
| FaxNumber: | 2155692776 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2013 | ||||||||
| LastUpdateDate: | 05/14/2013 | ||||||||
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| AuthorizedOfficialLastName: | STEIN | ||||||||
| AuthorizedOfficialFirstName: | BARBARA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2155691900 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | MD027814E | PA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | 261QP2000X | DC009374 | PA | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.