MEDICARE: DR. DAMIEN PETER CIASULLO DC

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	008019	PA

General Provider Information

NPI Number	:	1871505792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAMIEN PETER CIASULLO DC

Provider Business Mailing Address
First Line	:	6809 GERMANTOWN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-2112
Country	:	US
Telephone Number	:	215-844-4400
Fax Number	:	215-844-4070

Provider Business Practice Location Address
First Line	:	6809 GERMANTOWN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-2112
Country	:	US
Telephone Number	:	215-844-4400
Fax Number	:	215-844-4070

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

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	07/08/2007

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