Healthcare Provider Details

I. General information

NPI: 1235675992
Provider Name (Legal Business Name): ISFM LIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2017
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 S 4TH ST STE 254
PHILADELPHIA PA
19147-1573
US

IV. Provider business mailing address

525 S 4TH ST STE 254
PHILADELPHIA PA
19147-1573
US

V. Phone/Fax

Practice location:
  • Phone: 267-687-7875
  • Fax:
Mailing address:
  • Phone: 267-687-7875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberDC009450
License Number StatePA

VIII. Authorized Official

Name: DR. YOKE T TAN
Title or Position: OWNER
Credential: D.C.
Phone: 267-687-7875