Broad Axe Chiropractic Center
Organization Active NPI Chiropractor · Blue Bell, PA
NPI 1013103993 · NPPES record last updated May 24, 2023
Key facts
- NPI
- 1013103993
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- DC003375L (PA)
- Legal business name
- BROAD AXE CHIROPRACTIC CENTER
- Practice address
- 914 Skippack Pike
Blue Bell, PA 19422-1535 - Phone
- (215) 540-0776
- Fax
- (215) 570-9022
- NPI assigned
- Sep 24, 2007
- Organization subpart
- No
Authorized official
- Name
- Marie Winans
- Title
- Office MGR
- Phone
- (215) 540-0776
Practitioners 2
-
Patricia A Bona-Kustra, D.C.
-
Robert J Kustra, DC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120103000207 | PA | Part B Supplier - Clinic/Group Practice | 4981870540 |
Receives reassigned benefits from 2 practitioners Practice locations: Blue Bell, PA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | DC003375L | PA | Yes |
Addresses
Primary practice location
914 Skippack Pike
Blue Bell, PA 19422-1535
Mailing address
914 Skippack Pike
Blue Bell, PA 19422-1535
Phone (215) 540-0776
Other providers in Blue Bell, PA
- Andrea Cristina Bozak
- Erin E Brady
- Sharon Lynn Brauer
- Danielle Brazinski
- Kristen Brent
- Broad Axe Family Dentistry
- Rebecca Brossman
- Bayleigh Brown
- Cleveland D Brown
- Emily Brown
All providers in Blue Bell, PA · Chiropractor in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 24, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.