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General NPI Number Information
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NPI Number | 1295464576
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Entity Type | Individual
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Provider Name | GREGORY JOSEPH LATTANZI DC
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Gender | Male
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Dates
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Enumeration Date | 06/10/2022
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Last Update Date | 06/10/2022
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Provider Practice Location Address
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Address Line | 1717 SWEDE RD STE 106
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City | BLUE BELL
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State | PA
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Zip | 19422-3372
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Country | US
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Telephone | 877-946-4060
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Fax |
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Provider Business Mailing Address
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Address Line | 2920 HANNAH AVE APT H175
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City | EAST NORRITON
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State | PA
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Zip | 19401-1554
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Country | US
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Telephone | 484-402-8094
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Fax |
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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 | DC011748
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License Number State | PA
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