MEDICARE: CITYWIDE NORTH, PC

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

General Provider Information

NPI Number	:	1124628540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITYWIDE NORTH, PC

Provider Business Mailing Address
First Line	:	PO BOX 63960
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-7960
Country	:	US
Telephone Number	:	215-469-5000
Fax Number	:	215-469-5006

Provider Business Practice Location Address
First Line	:	2304-A NORTH BROAD STREET
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19132-4563
Country	:	US
Telephone Number	:	215-469-5000
Fax Number	:	215-469-5006

Authorized Official
Title or Position	:	CHIROPRACTOR PRESIDENT
Name	:	DR. PHILIP ANTHONY DIBARTOLO
Credential	:	DC
Telephone Number	:	215-469-5000

Provider Enumeration Date	:	10/26/2020
Last Update Date	:	10/26/2020

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Directions to “CITYWIDE NORTH, PC ” Practice Location

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