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General NPI Number Information
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NPI Number | 1407004013
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Entity Type | Organization
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Legal Business Name | SOUTHAMPTON CHIROPRACTIC & WELLNESS CENTER, PC
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Dates
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Enumeration Date | 09/08/2008
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Last Update Date | 09/08/2008
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Provider Practice Location Address
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Address Line | 454 SECOND STREET PIKE
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City | SOUTHAMPTON
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State | PA
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Zip | 18966-3814
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Country | US
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Telephone | 215-942-7990
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Fax |
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Provider Business Mailing Address
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Address Line | 454 SECOND STREET PIKE
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City | SOUTHAMPTON
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State | PA
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Zip | 18966-3814
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Country | US
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Telephone | 215-942-7990
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTOPHER A FIORDALISO
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Credential | DC
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Telephone | 215-942-7990
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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 | DC006513L
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License Number State | PA
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