Healthcare Provider Details

I. General information

NPI: 1831166883
Provider Name (Legal Business Name): DENISE LUELLA PRIMAVERA DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS DENISE LUELLA GRUBB

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4019 BETHLEHEM PIKE
TELFORD PA
18969-1126
US

IV. Provider business mailing address

106 QUINCE DRIVE
TELFORD PA
18969
US

V. Phone/Fax

Practice location:
  • Phone: 215-723-7900
  • Fax: 215-723-4481
Mailing address:
  • Phone: 215-721-6356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: