Provider Demographics
NPI:1174850630
Name:MBE1
Entity type:Organization
Organization Name:MBE1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRETTNEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAMSOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-420-1600
Mailing Address - Street 1:100 PIONEER LN STE 3
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-8786
Mailing Address - Country:US
Mailing Address - Phone:570-420-1600
Mailing Address - Fax:
Practice Address - Street 1:100 PIONEER LN STE 3
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-8786
Practice Address - Country:US
Practice Address - Phone:570-420-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADC005908L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty