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Organization
SOUTH PHILLY CHIROPRACTIC, LLC
Active
Organization
SOUTH PHILLY CHIROPRACTIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DONNA L STATON (BUSINESS MANAGER)
(215) 782-3891
Entity
Organization
Contact information
Practice address
1913 S BROAD ST, 1ST FLOOR, PHILADELPHIA, PA 19148-2216
(215) 755-5700
(215) 755-5800
Mailing address
1913 S BROAD ST, 1ST FLOOR, PHILADELPHIA, PA 19148-2216
(215) 755-5700
(215) 755-5800
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC010285
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1027305380001
—
PA
01
—
3805953000
IBX
PA
Enumeration date
02/09/2016
Last updated
02/09/2016
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