MEDICARE: DR. NATALIE MITLYANSKY

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	DC009099	PA

General Provider Information

NPI Number	:	1649210311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATALIE MITLYANSKY

Provider Business Mailing Address
First Line	:	360 COLDSPRING RD
Second Line	:
City	:	SOUTHAMPTON
State	:	PA
Zip	:	18966-3530
Country	:	US
Telephone Number	:	215-942-4112
Fax Number	:	215-223-2358

Provider Business Practice Location Address
First Line	:	2701 NORTH BROAD STREET
Second Line	:	1ST FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19132
Country	:	US
Telephone Number	:	215-223-2356
Fax Number	:	215-223-2358

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	07/09/2007

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