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General NPI Number Information
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NPI Number | 1225081631
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Entity Type | Individual
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Provider Name | JERRY STEVEN SANGIAMO D.C.
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Gender | Male
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 317 GORDON DR
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City | EXTON
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State | PA
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Zip | 19341-1201
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Country | US
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Telephone | 610-594-8522
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Fax | 610-594-6499
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Provider Business Mailing Address
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Address Line | 392 DEVON DR
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City | EXTON
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State | PA
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Zip | 19341-1781
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Country | US
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Telephone | 610-594-8522
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Fax | 610-594-6499
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC005947L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | X004477
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License Number State | NY
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