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General NPI Number Information
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NPI Number | 1942410170
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Entity Type | Organization
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Legal Business Name | DR. O. FAMILY CHIROPRACTIC
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 12/03/2012
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Provider Practice Location Address
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Address Line | 319 PRITCHARD LN
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City | WALLINGFORD
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State | PA
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Zip | 19086-6104
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Country | US
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Telephone | 215-514-6686
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Fax | 610-565-8493
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Provider Business Mailing Address
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Address Line | 211 N MONROE ST
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City | MEDIA
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State | PA
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Zip | 19063-3019
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Country | US
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Telephone | 215-514-6686
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Fax | 610-565-8493
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | FERNANDO O'LOUGHLIN
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Credential | D.C.
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Telephone | 215-514-6686
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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 | DC008761
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License Number State | PA
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