Provider Demographics
NPI:1093359739
Name:ROMAN, NEIL RICHARD (DC)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:RICHARD
Last Name:ROMAN
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:P.O. BOX 8918
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-8918
Mailing Address - Country:US
Mailing Address - Phone:215-782-3891
Mailing Address - Fax:215-782-1187
Practice Address - Street 1:1420 LOCUST STREET
Practice Address - Street 2:SUITE #220
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19102-4204
Practice Address - Country:US
Practice Address - Phone:215-546-0100
Practice Address - Fax:215-546-7225
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011513111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor