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General NPI Number Information
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NPI Number | 1497847404
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Entity Type | Organization
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Legal Business Name | NORTHEAST CHIROPRACTIC BODYSHOP, P.C.
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 12/20/2023
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Provider Practice Location Address
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Address Line | 1619 GRANT AVE STE 1
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City | PHILADELPHIA
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State | PA
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Zip | 19115-3162
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Country | US
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Telephone | 267-969-0082
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Fax | 267-686-8606
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Provider Business Mailing Address
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Address Line | 1619 GRANT AVE STE 1
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City | PHILADELPHIA
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State | PA
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Zip | 19115-3162
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Country | US
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Telephone | 267-969-0082
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Fax | 267-686-8606
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SEAN M. EPSTEIN
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Credential | D.C.
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Telephone | 267-969-0082
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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 | DC008795
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License Number State | PA
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