MEDICARE: DR. BRYAN H EHRLICH 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	DC004076-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC004076-L	OTHER	PA	STATE

General Provider Information

NPI Number	:	1558555375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN H EHRLICH D.C.

Provider Business Mailing Address
First Line	:	318 N LANSDOWNE AVE
Second Line	:
City	:	LANSDOWNE
State	:	PA
Zip	:	19050-1018
Country	:	US
Telephone Number	:	610-259-5855
Fax Number	:	610-259-3385

Provider Business Practice Location Address
First Line	:	318 N LANSDOWNE AVE
Second Line	:
City	:	LANSDOWNE
State	:	PA
Zip	:	19050-1018
Country	:	US
Telephone Number	:	610-259-5855
Fax Number	:	610-259-3385

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

Provider Enumeration Date	:	09/05/2007
Last Update Date	:	09/05/2007

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