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General NPI Number Information
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NPI Number | 1740305887
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Entity Type | Organization
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Legal Business Name | GARNET VALLEY SPROT AND SPINE CHIROPACTIC CTR
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 02/18/2013
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Provider Practice Location Address
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Address Line | 3039 FOULK ROAD
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City | GARNET VALLEY
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State | PA
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Zip | 19060
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Country | US
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Telephone | 610-361-0070
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Fax | 610-361-0071
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Provider Business Mailing Address
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Address Line | 3039 FAULK ROAD
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City | GARNET VALLEY
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State | PA
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Zip | 19060
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Country | US
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Telephone | 610-361-0070
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Fax | 610-361-0070
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. TIM A MARTIN
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Credential | D.C.
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Telephone | 610-361-0070
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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 | DC008836
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License Number State | PA
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