=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619957859
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DOMINICK GREGORY CARFELLO D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/21/2006
-----------------------------------------------------
Last Update Date | 06/24/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 520 N COLUMBUS BLVD SUITE 204
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19123-4226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-239-3097
-----------------------------------------------------
Fax | 215-239-3098
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 WENDOVER DR
-----------------------------------------------------
City | MOUNT LAUREL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08054-3326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-231-9008
-----------------------------------------------------
Fax | 215-925-4821
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC-2363-L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------