Healthcare Provider Details

I. General information

NPI: 1699885152
Provider Name (Legal Business Name): CANTWELL CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 SCHOOL LN
TELFORD PA
18969-2043
US

IV. Provider business mailing address

112 SCHOOL LN
TELFORD PA
18969-2043
US

V. Phone/Fax

Practice location:
  • Phone: 215-721-3998
  • Fax: 215-721-3990
Mailing address:
  • Phone: 215-721-3998
  • Fax: 215-721-3990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC009367
License Number StatePA

VIII. Authorized Official

Name: DR. JOSEPH BRIAN CANTWELL
Title or Position: PRESIDENT
Credential: DC
Phone: 215-721-3998