Healthcare Provider Details

I. General information

NPI: 1245326560
Provider Name (Legal Business Name): ROBERT JOHN NYAHAY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5810 GREENE ST
PHILADELPHIA PA
19144-2704
US

IV. Provider business mailing address

175 N CHURCH ST APT.3
SPRING CITY PA
19475-1838
US

V. Phone/Fax

Practice location:
  • Phone: 215-844-7359
  • Fax: 215-844-7402
Mailing address:
  • Phone: 610-792-4154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC006545L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: