Provider Demographics
NPI:1285858852
Name:PETRELLI CHIROPRACTIC & REHABILITATION, INC.
Entity Type:Organization
Organization Name:PETRELLI CHIROPRACTIC & REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER , PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-670-2225
Mailing Address - Street 1:220 SOUTH BROAD ST.
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102
Mailing Address - Country:US
Mailing Address - Phone:215-670-2225
Mailing Address - Fax:215-670-9662
Practice Address - Street 1:220 SOUTH BROAD STREET
Practice Address - Street 2:8TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102
Practice Address - Country:US
Practice Address - Phone:215-670-2225
Practice Address - Fax:215-670-9662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-007963L111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA050433Medicare ID - Type Unspecified
PAU86606Medicare UPIN