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General NPI Number Information
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NPI Number | 1639280027
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Entity Type | Organization
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Legal Business Name | SPINEDRAULIX CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11685 BUSTLETON AVE #C
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City | PHILADELPHIA
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State | PA
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Zip | 19116
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Country | US
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Telephone | 215-969-1116
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Fax | 215-682-7328
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Provider Business Mailing Address
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Address Line | 2030 COUNTY LINE RD SUITE 161
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City | HUNTINGDON VALLEY
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State | PA
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Zip | 19006
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Country | US
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Telephone | 215-901-2812
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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. ROBERT L MELIODON
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Credential | D.C.
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Telephone | 215-969-1116
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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 | DC-007396L
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License Number State | PA
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