Healthcare Provider Details

I. General information

NPI: 1295830867
Provider Name (Legal Business Name): VINCENT PETRELLI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 WALNUT ST STE 606
PHILADELPHIA PA
19102-4005
US

IV. Provider business mailing address

1420 WALNUT ST STE 606
PHILADELPHIA PA
19102-4005
US

V. Phone/Fax

Practice location:
  • Phone: 215-670-2225
  • Fax: 215-670-9662
Mailing address:
  • Phone: 215-670-2225
  • Fax: 215-670-9662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-09763-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: