MEDICARE: NORTHEAST FAMILY MEDICAL AND REHABILITATION CENTER, 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	111NR0400X	Rehabilitation Chiropractor

General Provider Information

NPI Number	:	1679795843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST FAMILY MEDICAL AND REHABILITATION CENTER, P.C

Provider Business Mailing Address
First Line	:	1306 COTTMAN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-3606
Country	:	US
Telephone Number	:	215-745-1212
Fax Number	:	215-745-4427

Provider Business Practice Location Address
First Line	:	1306 COTTMAN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-3606
Country	:	US
Telephone Number	:	215-745-1212
Fax Number	:	215-745-4427

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK BROWN
Credential	:	D.C.
Telephone Number	:	215-745-1212

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	06/05/2013

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