Healthcare Provider Details

I. General information

NPI: 1841530243
Provider Name (Legal Business Name): GARNET VALLEY SPORT & SPINE CHIROPRACTIC CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2013
Last Update Date: 08/05/2013
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 TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC008836
License Number StatePA

VIII. Authorized Official

Name: DR. TIMOTHY MARTIN
Title or Position: OWNER
Credential: D.C
Phone: 610-361-0070