Spectrum Wellness LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC005180L Issued in PA

Legal business name

SPECTRUM WELLNESS LLC

Practice address

2321 Huntingdon Pike
Huntingdon Valley, PA 19006-6109

Phone

(215) 938-8500

Fax

(251) 938-8586

NPI assigned

Sep 27, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Kenneth M. Goldman, D.C.

Title

Chiropractic Doctor

Phone

(215) 938-8500

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208304000000",
    "number": "1821189564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2321 HUNTINGDON PIKE",
            "city": "HUNTINGDON VALLEY",
            "state": "PA",
            "postal_code": "190066109",
            "telephone_number": "215-938-8500",
            "fax_number": "251-938-8586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2321 HUNTINGDON PIKE",
            "city": "HUNTINGDON VALLEY",
            "state": "PA",
            "postal_code": "190066109",
            "telephone_number": "215-938-8500",
            "fax_number": "251-938-8586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-27",
        "last_updated": "2008-04-16",
        "status": "A",
        "authorized_official_last_name": "GOLDMAN",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "CHIROPRACTIC DOCTOR",
        "authorized_official_telephone_number": "215-938-8500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "DC005180L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "1818597",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENCE BLUE CROSS",
            "identifier": "2674216000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "0043800",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 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.