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Organization
TRI-STATE SPORT AND SPINE, PLLC
Active
Organization
TRI-STATE SPORT AND SPINE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL R DOUGHERTY DC (PRESIDENT)
(215) 251-8526
Entity
Organization
Contact information
Practice address
9331 OLD BUSTLETON AVE, SUITE 101, PHILADELPHIA, PA 19115-4204
(215) 251-8526
(215) 673-1980
Mailing address
110 WHARTON ST, PHILADELPHIA, PA 19147-5425
(215) 251-8526
(215) 673-1980
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
DC010688
PA
Other
Enumeration date
10/21/2014
Last updated
10/21/2014
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