| |
1653 The Fairway, Suite 214, Jenkintown, PA 19046-1420 | |
(215) 886-3000 | |
(215) 357-5764 |
Full Name | |
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Type | Facility |
Speciality | General Practice |
Location | 1653 The Fairway, Jenkintown, Pennsylvania |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1720378441 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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111NS0005X | Chiropractor - Sports Physician | 2790-L AJ (Pennsylvania) | Secondary |
208D00000X | General Practice | 5243 (Pennsylvania) | Primary |
Provider Name | Glen A Nathan |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1083890545 PECOS PAC ID: 6709953599 Enrollment ID: I20080919000440 |
Mailing Address | Practice Location Address |
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1653 The Fairway, Suite 214, Jenkintown, PA 19046-1420 Ph: (215) 886-3000 | 1653 The Fairway, Suite 214, Jenkintown, PA 19046-1420 Ph: (215) 886-3000 |