MEDICARE: NEIL RICHARD ROMAN D.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC011513	PA

General Provider Information

NPI Number	:	1093359739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEIL RICHARD ROMAN D.C

Provider Business Mailing Address
First Line	:	P.O. BOX 8918
Second Line	:
City	:	ELKINS PARK
State	:	PA
Zip	:	19027-8918
Country	:	US
Telephone Number	:	215-782-3891
Fax Number	:	215-782-1187

Provider Business Practice Location Address
First Line	:	1420 LOCUST STREET
Second Line	:	SUITE #220
City	:	PHILA
State	:	PA
Zip	:	19102-4204
Country	:	US
Telephone Number	:	215-546-0100
Fax Number	:	215-546-7225

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2019
Last Update Date	:	11/06/2019

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