Healthcare Provider Details

I. General information

NPI: 1134319189
Provider Name (Legal Business Name): SPRUCE CHIROPRACTIC HEALTH CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 SPRUCE ST
PHILADELPHIA PA
19102-4533
US

IV. Provider business mailing address

1421 SPRUCE ST
PHILADELPHIA PA
19102-4533
US

V. Phone/Fax

Practice location:
  • Phone: 215-735-2997
  • Fax: 215-735-5222
Mailing address:
  • Phone: 215-735-2997
  • Fax: 215-735-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW CHARLES INDRISO
Title or Position: PRESIDENT
Credential: D.C.
Phone: 215-735-2997