Healthcare Provider Details

I. General information

NPI: 1073547329
Provider Name (Legal Business Name): THOMAS P. CANSECO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 01/27/2021
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4453 PENN AVE STE 6
SINKING SPRING PA
19608-8620
US

IV. Provider business mailing address

4453 PENN AVE STE 6
SINKING SPRING PA
19608-8620
US

V. Phone/Fax

Practice location:
  • Phone: 610-750-6804
  • Fax: 610-750-5295
Mailing address:
  • Phone: 610-750-6804
  • Fax: 610-750-5295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License NumberDC009154
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: