Healthcare Provider Details

I. General information

NPI: 1619917549
Provider Name (Legal Business Name): MARK CAVALLO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 WEST JOHNSON HWY
EAST NORRITON PA
19401
US

IV. Provider business mailing address

304 WEST JOHNSON HIGHWAY
EAST NORRITON PA
19401
US

V. Phone/Fax

Practice location:
  • Phone: 484-808-8888
  • Fax: 484-808-8890
Mailing address:
  • Phone: 484-808-8888
  • Fax: 484-808-8890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC3721L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: