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General NPI Number Information
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NPI Number | 1003352725
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Entity Type | Organization
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Legal Business Name | CREATIVE HEALTH AND SPINE
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Dates
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Enumeration Date | 01/19/2017
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Last Update Date | 08/28/2023
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Provider Practice Location Address
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Address Line | 616 LANCASTER AVE
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City | BERWYN
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State | PA
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Zip | 19312-1663
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Country | US
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Telephone | 610-722-0240
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Fax |
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Provider Business Mailing Address
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Address Line | 616 LANCASTER AVE
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City | BERWYN
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State | PA
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Zip | 19312-1663
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Country | US
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Telephone | 610-722-0240
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. ANDREW FETTERMAN
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Credential | D.C.
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Telephone | 610-722-0240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | DC008727
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | DC009859
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License Number State | PA
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