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Organization
WALCOTT CHIROPRACTIC, P.C.
Active
Organization
WALCOTT CHIROPRACTIC, P.C.
Active
Other names
Advanced Wellness Center of PA
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRISTOPHER VAILL WALCOTT D.C. (PRESIDENT)
(215) 493-1590
Entity
Organization
Contact information
Practice address
14260 BUSTLETON AVE, PHILADELPHIA, PA 19116-1108
(215) 676-0104
Mailing address
1548 REVERE RD, YARDLEY, PA 19067-4351
(215) 493-1590
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC007908L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0060935000
AMERIHEALTH PIN ID
PA
01
—
056172
BLUE SHIELD
PA
01
—
1437125
BLUE SHIELD GROUP ID
PA
01
—
2125718000
PERSONAL CHOICE GROUP ID
PA
01
—
2192178
UNITED HEALTHCARE
PA
01
—
3063269
AETNA HMO
PA
01
—
7979272
AETNA TRADITIONAL
PA
01
—
DD6376
RR MEDICARE GROUP ID
PA
01
—
P00240657
RR MEDICARE
PA
Enumeration date
06/24/2006
Last updated
01/28/2008
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