Healthcare Provider Details

I. General information

NPI: 1558423988
Provider Name (Legal Business Name): LIONVILLE CHIROPRACTIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 GORDON DR
EXTON PA
19341-1201
US

IV. Provider business mailing address

317 GORDON DR
EXTON PA
19341-1201
US

V. Phone/Fax

Practice location:
  • Phone: 610-594-8522
  • Fax: 610-594-6499
Mailing address:
  • Phone: 610-594-8522
  • Fax: 610-594-6499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-006464-L
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-005947-L
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-004583-L
License Number State

VIII. Authorized Official

Name: DR. MATTHEW DUDDY
Title or Position: OWNER
Credential: D.C.
Phone: 610-594-8522