Healthcare Provider Details

I. General information

NPI: 1609344332
Provider Name (Legal Business Name): AVON CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2018
Last Update Date: 11/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10752 BUSTLETON AVE
PHILADELPHIA PA
19116-3367
US

IV. Provider business mailing address

10752 BUSTLETON AVE
PHILADELPHIA PA
19116-3367
US

V. Phone/Fax

Practice location:
  • Phone: 215-613-5929
  • Fax: 215-613-5929
Mailing address:
  • Phone: 215-613-5929
  • Fax: 215-613-5929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LINDA AMOAH
Title or Position: CHIROPRACTIC ASSISTANT
Credential:
Phone: 215-338-8840