MEDICARE: SPRING CHIROPRACTIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC00703L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2045561000	OTHER	PA	IBC

General Provider Information

NPI Number	:	1629257779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRING CHIROPRACTIC

Provider Business Mailing Address
First Line	:	7707 OGONTZ AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19150-1818
Country	:	US
Telephone Number	:	216-286-0934
Fax Number	:

Provider Business Practice Location Address
First Line	:	7707 OGONTZ AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19150-1818
Country	:	US
Telephone Number	:	216-286-0934
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DONALD LOUIS DOYLE
Credential	:	DC
Telephone Number	:	267-286-0984

Provider Enumeration Date	:	10/25/2007
Last Update Date	:	10/25/2007

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Directions to “SPRING CHIROPRACTIC ” Practice Location

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