Healthcare Provider Details

I. General information

NPI: 1447375779
Provider Name (Legal Business Name): VINCENT GELEZINSKY JR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

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:
Title or Position:
Credential:
Phone: