Radiant Life Chiropractic LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC011154 Issued in PA

Legal business name

RADIANT LIFE CHIROPRACTIC LLC

Practice address

319 W County Line Rd Ste 1
Hatboro, PA 19040-1605

Phone

(215) 259-5100

Fax

(484) 845-3177

NPI assigned

Jun 21, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Andrew Gerald Agasar, DCNPI 1841640273

Title

Manager

Phone

(215) 259-5100

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Andrew Gerald Agasar, D.C.

  • Chiropractor
  • Hatboro, PA
  • NPI 1841640273
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1466467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609632000000",
    "number": "1164872156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "319 W COUNTY LINE RD STE 1",
            "city": "HATBORO",
            "state": "PA",
            "postal_code": "190401605",
            "telephone_number": "215-259-5100",
            "fax_number": "484-845-3177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 W COUNTY LINE RD STE 1",
            "city": "HATBORO",
            "state": "PA",
            "postal_code": "190401605",
            "telephone_number": "215-259-5100",
            "fax_number": "484-845-3177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIANT LIFE CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-21",
        "last_updated": "2021-01-03",
        "certification_date": "2021-01-03",
        "status": "A",
        "authorized_official_last_name": "AGASAR",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "GERALD",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "215-259-5100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "DC011154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Hatboro, PA
• Providers in Hatboro, PA by specialty
• Chiropractor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.