Healthcare Provider Details

I. General information

NPI: 1881837318
Provider Name (Legal Business Name): GINO ZITA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 W TABOR RD SUITE 306
PHILADELPHIA PA
19141-3038
US

IV. Provider business mailing address

PO BOX 1057
MORRISVILLE PA
19067-9057
US

V. Phone/Fax

Practice location:
  • Phone: 215-745-5500
  • Fax:
Mailing address:
  • Phone: 215-745-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC004886L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: