Individual
DR. PETER SHAUN KAVANAUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
3301 RYAN AVE, PHILADELPHIA, PA 19136-4301
(215) 332-8686
(215) 332-8691
Mailing address
3301 RYAN AVE, PHILADELPHIA, PA 19136
(215) 332-8686
(215) 332-8691
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1897
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0061018000
KEYSTONE
PA
05
—
087374
—
PA
01
—
2142140000
PERSONAL CHOICE
PA
Enumeration date
12/19/2006
Last updated
02/07/2012
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