Healthcare Provider Details

I. General information

NPI: 1174670160
Provider Name (Legal Business Name): EMANUEL SANFILIPPO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 MADISON AVE S
HAMMONTON NJ
08037-1222
US

IV. Provider business mailing address

PO BOX 285
HAMMONTON NJ
08037-0285
US

V. Phone/Fax

Practice location:
  • Phone: 609-561-7247
  • Fax: 609-567-7947
Mailing address:
  • Phone: 609-561-7247
  • Fax: 609-567-7947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number38MC00416700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC003977L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: