MEDICARE: STEVEN MICHAEL REALDINE JR. 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	F1-0011087	DE

General Provider Information

NPI Number	:	1922734656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN MICHAEL REALDINE JR. DC

Provider Business Mailing Address
First Line	:	3301 RYAN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-4301
Country	:	US
Telephone Number	:	215-332-8686
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 RYAN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-4301
Country	:	US
Telephone Number	:	215-332-8686
Fax Number	:

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

Provider Enumeration Date	:	07/26/2022
Last Update Date	:	07/26/2022

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