Healthcare Provider Details

I. General information

NPI: 1326171646
Provider Name (Legal Business Name): ROGER FARRELL LEVY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1438 SNYDER AVE
PHILADELPHIA PA
19145-3936
US

IV. Provider business mailing address

1438 SNYDER AVE
PHILADELPHIA PA
19145-3936
US

V. Phone/Fax

Practice location:
  • Phone: 215-271-6000
  • Fax: 215-271-4115
Mailing address:
  • Phone: 215-271-6000
  • Fax: 215-271-4115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC-6420-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: