Healthcare Provider Details

I. General information

NPI: 1477512374
Provider Name (Legal Business Name): STUART B TOLLEN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 JOHNSON ST
JENKINTOWN PA
19046-2705
US

IV. Provider business mailing address

435 JOHNSON ST
JENKINTOWN PA
19046-2705
US

V. Phone/Fax

Practice location:
  • Phone: 215-885-8730
  • Fax: 215-885-7665
Mailing address:
  • Phone: 215-885-8730
  • Fax: 215-885-7665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC004405L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: