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Organization
TRI-STATE SPORT AND SPINE, PLLC
Active
Organization
TRI-STATE SPORT AND SPINE, PLLC
Active
Parent organization
TRI-STATE SPORT AND SPINE, PLLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
TRI-STATE SPORT AND SPINE, PLLC
Authorized official
MICHAEL DOUGHERTY DC (OWNER)
(609) 760-0386
Entity
Organization
Contact information
Practice address
100 SOUTH BROAD STREET, 1800, PHILADELPHIA, PA 19110
(215) 988-9503
(215) 988-9533
Mailing address
110 WHARTON ST, PHILADELPHIA, PA 19147-5425
(609) 760-0386
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC010688
PA
Other
Enumeration date
02/08/2016
Last updated
02/08/2016
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