MEDICARE: CARDONICK CHIROPRACTIC 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	DC5192	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0527913	OTHER	PA	AETNA
2	0237787000	OTHER	PA	PERSONAL CHOICE

General Provider Information

NPI Number	:	1548444607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDONICK CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	23 EAST DURHAM STREET
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-1821
Country	:	US
Telephone Number	:	215-242-8632
Fax Number	:	215-242-4226

Provider Business Practice Location Address
First Line	:	23 EAST DURHAM ST.
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-1821
Country	:	US
Telephone Number	:	215-242-8632
Fax Number	:	215-242-4226

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. BRETT DAVID CARDONICK
Credential	:	DC
Telephone Number	:	215-242-8632

Provider Enumeration Date	:	12/26/2007
Last Update Date	:	12/26/2007

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