Healthcare Provider Details

I. General information

NPI: 1386838902
Provider Name (Legal Business Name): PETER DEAN REDMOND D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 S 17TH ST FL 30
PHILADELPHIA PA
19103-6207
US

IV. Provider business mailing address

PO BOX 1237
EXTON PA
19341-0940
US

V. Phone/Fax

Practice location:
  • Phone: 215-735-5911
  • Fax:
Mailing address:
  • Phone: 610-524-2171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC006411L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: