Healthcare Provider Details

I. General information

NPI: 1285858852
Provider Name (Legal Business Name): PETRELLI CHIROPRACTIC & REHABILITATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 WALNUT ST STE 606
PHILADELPHIA PA
19102-4005
US

IV. Provider business mailing address

1420 WALNUT ST STE 606
PHILADELPHIA PA
19102-4005
US

V. Phone/Fax

Practice location:
  • Phone: 215-670-2225
  • Fax: 215-670-9662
Mailing address:
  • Phone: 215-670-2225
  • Fax: 215-670-9662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC-007963L
License Number StatePA

VIII. Authorized Official

Name: DR. VINCENT PETRELLI
Title or Position: OWNER , PRESIDENT
Credential: D.C.
Phone: 215-670-2225