Healthcare Provider Details

I. General information

NPI: 1710122296
Provider Name (Legal Business Name): MICHELLE KRISTEN NAUDASCHER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 BUSTLETON PIKE
CHURCHVILLE PA
18966-1508
US

IV. Provider business mailing address

120 BUSTLETON PIKE
CHURCHVILLE PA
18966-1508
US

V. Phone/Fax

Practice location:
  • Phone: 215-322-1300
  • Fax: 215-322-5301
Mailing address:
  • Phone: 215-322-1300
  • Fax: 215-322-5301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC010033
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC010033
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC010033
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: