Walcott Chiropractic, P.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC007908L Issued in PA

Legal business name

WALCOTT CHIROPRACTIC, P.C.

Doing business as

Advanced Wellness Center of PA

Practice address

14260 Bustleton Ave
Philadelphia, PA 19116-1108

Phone

(215) 676-0104

NPI assigned

Jun 24, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Christopher Vaill Walcott, D.C.

Title

President

Phone

(215) 493-1590

Specialties & licenses 1

Addresses

Other identifiers 12

Other names 1

• Advanced Wellness Center of PA Doing business as

Locations

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

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201478400000",
    "number": "1336175918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1548 REVERE RD",
            "city": "YARDLEY",
            "state": "PA",
            "postal_code": "190674351",
            "telephone_number": "215-493-1590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14260 BUSTLETON AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191161108",
            "telephone_number": "215-676-0104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALCOTT CHIROPRACTIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-24",
        "last_updated": "2008-01-28",
        "status": "A",
        "authorized_official_last_name": "WALCOTT",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "VAILL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "215-493-1590",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "DC007908L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL CHOICE GROUP ID",
            "identifier": "2125718000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE GROUP ID",
            "identifier": "2125718000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "3063269",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA TRADITIONAL",
            "identifier": "7979272",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH PIN ID",
            "identifier": "0060935000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "056172",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00240657",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD GROUP ID",
            "identifier": "1437125",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE GROUP ID",
            "identifier": "DD6376",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL CHOICE",
            "identifier": "0060935000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE",
            "identifier": "0060935000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "2192178",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Wellness Center of PA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.