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General NPI Number Information
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NPI Number | 1710279831
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Entity Type | Organization
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Legal Business Name | UPPER CERVICAL CHIROPRACTIC NEUROLOGY CENTER, P.C.
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Dates
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Enumeration Date | 05/08/2011
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Last Update Date | 08/01/2011
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Provider Practice Location Address
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Address Line | 533 W UWCHLAN AVE SUITE 101
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City | DOWNINGTOWN
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State | PA
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Zip | 19335-1763
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Country | US
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Telephone | 484-593-0328
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Fax |
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Provider Business Mailing Address
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Address Line | 533 W UWCHLAN AVE SUITE 101
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City | DOWNINGTOWN
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State | PA
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Zip | 19335-1763
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Country | US
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Telephone | 484-593-0328
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN ANTHONY CONICELLO
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Credential | D.C.
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Telephone | 484-593-0328
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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 | DC009298
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License Number State | PA
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