Provider Demographics
NPI:1174565717
Name:LEGNOLA AND MARCUSSEN CHIROPRACTIC ASSOCIATES
Entity type:Organization
Organization Name:LEGNOLA AND MARCUSSEN CHIROPRACTIC ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARCUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:484-688-0664
Mailing Address - Street 1:1717 SWEDE ROAD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422
Mailing Address - Country:US
Mailing Address - Phone:484-688-0664
Mailing Address - Fax:484-688-0667
Practice Address - Street 1:1717 SWEDE ROAD
Practice Address - Street 2:SUITE 106
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422
Practice Address - Country:US
Practice Address - Phone:484-688-0664
Practice Address - Fax:484-688-0667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006990L111N00000X
PADC006991L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2130234000OtherINDEP BC
2130234000OtherHMO INDEP BC
PA092793Medicare ID - Type Unspecified