Provider Demographics
NPI:1326198185
Name:BERDICHEVSKY, NATALY (DC)
Entity Type:Individual
Prefix:DR
First Name:NATALY
Middle Name:
Last Name:BERDICHEVSKY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 E STREET RD STE 9
Mailing Address - Street 2:PO BOX 286
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6100
Mailing Address - Country:US
Mailing Address - Phone:215-364-9708
Mailing Address - Fax:215-364-9726
Practice Address - Street 1:9867 BUSTLETON AVE # B
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-2611
Practice Address - Country:US
Practice Address - Phone:215-698-8171
Practice Address - Fax:215-364-9726
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005345L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU44616Medicare UPIN