=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093882474
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHEN MICHAEL GAROFALO D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2006
-----------------------------------------------------
Last Update Date | 03/27/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6404 ROOSEVELT BLVD SUITE 1C
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19149-9998
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-788-1789
-----------------------------------------------------
Fax | 215-437-1407
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6404 ROOSEVELT BLVD STE 1C-3
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19149-2943
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-788-1789
-----------------------------------------------------
Fax | 215-437-1407
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC005542L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------