MEDICARE: ERIE AVENUE CHIROPRACTIC CENTER

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	DC007780	PA

General Provider Information

NPI Number	:	1255542080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERIE AVENUE CHIROPRACTIC CENTER

Provider Business Mailing Address
First Line	:	701 W ERIE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-4432
Country	:	US
Telephone Number	:	215-229-7349
Fax Number	:	215-229-7354

Provider Business Practice Location Address
First Line	:	701 W ERIE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-4432
Country	:	US
Telephone Number	:	215-229-7349
Fax Number	:	215-229-7354

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DARREN MICHAEL LUGIANO
Credential	:	DC
Telephone Number	:	215-229-7349

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	08/22/2020

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