Organization
NORTHERN LIBERTIES WELLNESS GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LOLAMARIE DAVIS (ADMINISTRATOR)
(215) 239-3096
Entity
Organization
Contact information
Practice address
520 N COLUMBUS BLVD, SUITE 202, PHILADELPHIA, PA 19123-4226
(215) 239-3097
(215) 239-3098
Mailing address
PO BOX 9900, HAMILTON, NJ 08650-1900
(215) 239-3097
(215) 239-3098
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
DC002363
PA
208D00000X
General Practice Physician
Primary
OS011923
PA
Other
Enumeration date
08/06/2015
Last updated
08/06/2015
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