Healthcare Provider Details

I. General information

NPI: 1376668616
Provider Name (Legal Business Name): GELEZINSKY CHIROPRACTIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 N MAIN ST
SOUDERTON PA
18964-1609
US

IV. Provider business mailing address

220 N MAIN ST
SOUDERTON PA
18964-1609
US

V. Phone/Fax

Practice location:
  • Phone: 215-723-9166
  • Fax: 215-723-9197
Mailing address:
  • Phone: 215-723-9166
  • Fax: 215-723-9197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC006746L
License Number StatePA

VIII. Authorized Official

Name: DR. VINCENT JOHN GELEZINSKY JR.
Title or Position: DOCTOR
Credential: D.C.
Phone: 215-256-9466