Healthcare Provider Details

I. General information

NPI: 1629098371
Provider Name (Legal Business Name): MITCHELL C HARDING D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 ARCH ST 1ST FLOOR
PHILADELPHIA PA
19102-1507
US

IV. Provider business mailing address

1600 ARCH ST UNIT 502
PHILADELPHIA PA
19103-2028
US

V. Phone/Fax

Practice location:
  • Phone: 215-557-9090
  • Fax: 215-557-9089
Mailing address:
  • Phone: 570-764-0528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC008941
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: