Healthcare Provider Details

I. General information

NPI: 1912198060
Provider Name (Legal Business Name): DELAWARE VALLEY CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2812 EGYPT ROAD
AUDUBON PA
19403-2195
US

IV. Provider business mailing address

2812 EGYPT ROAD
AUDUBON PA
19403-2195
US

V. Phone/Fax

Practice location:
  • Phone: 610-666-7400
  • Fax: 610-666-7558
Mailing address:
  • Phone: 610-666-7400
  • Fax: 610-666-7558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberDC002744L
License Number StatePA

VIII. Authorized Official

Name: DR. FREDERICK JAMES COLANTUONI
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 610-666-7400