Provider Demographics
NPI:1407800337
Name:DELUCA CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:DELUCA CHIROPRACTIC, LLC
Other - Org Name:ALLIANCE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRISTA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DELUCA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-723-7500
Mailing Address - Street 1:610 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-1219
Mailing Address - Country:US
Mailing Address - Phone:215-723-7500
Mailing Address - Fax:215-723-8711
Practice Address - Street 1:610 E BROAD ST
Practice Address - Street 2:
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964-1219
Practice Address - Country:US
Practice Address - Phone:215-723-7500
Practice Address - Fax:215-723-8711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007516L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty