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General NPI Number Information
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NPI Number | 1992468631
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Entity Type | Organization
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Legal Business Name | VICTORY CHIROPRACTIC AND PERFORMANCE LLC
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Dates
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Enumeration Date | 10/19/2021
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Last Update Date | 01/27/2022
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Provider Practice Location Address
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Address Line | 1404 MANOA RD
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City | WYNNEWOOD
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State | PA
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Zip | 19096-3208
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Country | US
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Telephone | 484-443-3673
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Fax | 215-770-0830
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Provider Business Mailing Address
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Address Line | PO BOX 11
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City | MORTON
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State | PA
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Zip | 19070-0011
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Country | US
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Telephone | 484-641-7171
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Fax | 215-770-0830
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Authorized Official
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Title or Position | OWNER
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Name | DR. VICTORY ANYIAM
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Credential | DR
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Telephone | 484-641-7171
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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 |
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License Number State |
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