Provider Demographics
NPI:1003138686
Name:PHAM, SEAN (DC)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:PHAM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-4825
Mailing Address - Country:US
Mailing Address - Phone:215-218-4025
Mailing Address - Fax:215-952-0847
Practice Address - Street 1:603 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-4825
Practice Address - Country:US
Practice Address - Phone:215-218-4025
Practice Address - Fax:215-952-0847
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor