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General NPI Number Information
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NPI Number | 1922561257
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Entity Type | Organization
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Legal Business Name | CITYWIDE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 04/12/2019
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Last Update Date | 04/12/2019
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Provider Practice Location Address
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Address Line | 7028 TERMINAL SQ
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City | UPPER DARBY
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State | PA
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Zip | 19082-2341
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Country | US
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Telephone | 215-469-5000
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Fax | 215-469-5001
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Provider Business Mailing Address
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Address Line | 1 DORATO DR
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City | EGG HARBOR TWP
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State | NJ
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Zip | 08234-7504
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Country | US
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Telephone | 609-335-1093
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. PHILIP ANTHONY DIBARTOLO
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Credential | DC
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Telephone | 215-469-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number |
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License Number State |
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