Healthcare Provider Details

I. General information

NPI: 1497757983
Provider Name (Legal Business Name): DENISE LYNNE DEFRIES D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2870 CONCORD RD
ASTON PA
19014-2946
US

IV. Provider business mailing address

2870 CONCORD RD
ASTON PA
19014-2946
US

V. Phone/Fax

Practice location:
  • Phone: 484-480-4544
  • Fax: 484-480-4546
Mailing address:
  • Phone: 484-480-4544
  • Fax: 484-480-4546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-003713-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: