MEDICARE: COOPERSBURG FAMILY CHIROPRACTIC LLC

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	DC006858L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	901524	OTHER		PTAN

General Provider Information

NPI Number	:	1750395513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COOPERSBURG FAMILY CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	229 N MAIN ST
Second Line	:
City	:	COOPERSBURG
State	:	PA
Zip	:	18036-1529
Country	:	US
Telephone Number	:	610-282-2525
Fax Number	:	610-282-3372

Provider Business Practice Location Address
First Line	:	229 N MAIN ST
Second Line	:
City	:	COOPERSBURG
State	:	PA
Zip	:	18036-1529
Country	:	US
Telephone Number	:	610-282-2525
Fax Number	:	610-282-3372

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	DR. ANTHONY P COLASURDO
Credential	:	D.C.
Telephone Number	:	610-282-2525

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	01/11/2016

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