Healthcare Provider Details

I. General information

NPI: 1477763308
Provider Name (Legal Business Name): TANCREDI CHIROPRACTIC & REHABILITATION CENTER P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 REED RD
BROOMALL PA
19008-3505
US

IV. Provider business mailing address

600 REED RD
BROOMALL PA
19008-3505
US

V. Phone/Fax

Practice location:
  • Phone: 610-353-9400
  • Fax: 610-353-2280
Mailing address:
  • Phone: 610-353-9400
  • Fax: 610-353-2280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC003716L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT013686L
License Number StatePA

VIII. Authorized Official

Name: DR. MICHAEL JOSEPH TANCREDI
Title or Position: PRESIDENT
Credential: D.C
Phone: 610-353-9400