Provider Demographics
NPI:1164639308
Name:SOTTILE, PETER S (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:S
Last Name:SOTTILE
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 1:4700 TOWNSHIP LINE RD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-4222
Mailing Address - Country:US
Mailing Address - Phone:610-789-5555
Mailing Address - Fax:
Practice Address - Street 1:4700 TOWNSHIP LINE RD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-4222
Practice Address - Country:US
Practice Address - Phone:610-789-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007180L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor