MEDICARE: BELLA VISTA FAMILY CHIROPRACTIC, P.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	DC007773L	PA

General Provider Information

NPI Number	:	1497020010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLA VISTA FAMILY CHIROPRACTIC, P.C.

Provider Business Mailing Address
First Line	:	826 CHRISTIAN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-3947
Country	:	US
Telephone Number	:	607-235-0455
Fax Number	:

Provider Business Practice Location Address
First Line	:	826 CHRISTIAN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-3947
Country	:	US
Telephone Number	:	607-235-0455
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID MARTIN
Credential	:	D.C.
Telephone Number	:	607-235-0455

Provider Enumeration Date	:	03/14/2012
Last Update Date	:	03/14/2012

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