MEDICARE: DR. DEEPAK SUD 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	DC009823	PA

General Provider Information

NPI Number	:	1316950868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEEPAK SUD D.C.

Provider Business Mailing Address
First Line	:	52 RAMSGATE CT
Second Line	:
City	:	BLUE BELL
State	:	PA
Zip	:	19422-2549
Country	:	US
Telephone Number	:	215-767-8269
Fax Number	:

Provider Business Practice Location Address
First Line	:	228 W CHELTEN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-3803
Country	:	US
Telephone Number	:	215-951-6570
Fax Number	:

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	07/09/2016

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