Healthcare Provider Details

I. General information

NPI: 1104987098
Provider Name (Legal Business Name): DENISE PRIMAVERA D.C., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4019 BETHLEHEM PIKE
TELFORD PA
18969-1126
US

IV. Provider business mailing address

4019 BETHLEHEM PIKE
TELFORD PA
18969-1126
US

V. Phone/Fax

Practice location:
  • Phone: 215-723-7900
  • Fax: 215-723-4481
Mailing address:
  • Phone: 215-723-7900
  • Fax: 215-723-4481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC005445L
License Number StatePA

VIII. Authorized Official

Name: DR. DENISE L. PRIMAVERA
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 215-723-7900