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General NPI Number Information
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NPI Number | 1366800062
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Entity Type | Organization
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Legal Business Name | SOUTH PHILLY CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 02/09/2016
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Last Update Date | 02/09/2016
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Provider Practice Location Address
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Address Line | 1913 S BROAD ST 1ST FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19148-2216
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Country | US
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Telephone | 215-755-5700
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Fax | 215-755-5800
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Provider Business Mailing Address
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Address Line | 1913 S BROAD ST 1ST FLOOR
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City | PHILADELPHIA
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State | PA
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Zip | 19148-2216
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Country | US
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Telephone | 215-755-5700
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Fax | 215-755-5800
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MS. DONNA L STATON
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Credential |
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Telephone | 215-782-3891
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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 | DC010285
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License Number State | PA
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