Provider Demographics
NPI:1154446789
Name:POTERA, FRANK DAVID (DC)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:DAVID
Last Name:POTERA
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 1:14 MAPLE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040
Mailing Address - Country:US
Mailing Address - Phone:215-778-1529
Mailing Address - Fax:
Practice Address - Street 1:14 MAPLE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040
Practice Address - Country:US
Practice Address - Phone:215-778-1529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003292L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA508991OtherINDEPENDENT BC BS
PA2150061005OtherPERSONAL CHOICE