Healthcare Provider Details

I. General information

NPI: 1235522848
Provider Name (Legal Business Name): STEPHANIE SOTO D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2015
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3039 FOULK RD
GARNET VALLEY PA
19060-1701
US

IV. Provider business mailing address

3039 FOULK RD
GARNET VALLEY PA
19060-1701
US

V. Phone/Fax

Practice location:
  • Phone: 610-361-0070
  • Fax: 610-361-0071
Mailing address:
  • Phone: 610-361-0070
  • Fax: 610-361-0071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH 11461
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC011136
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: