Provider Demographics
NPI:1417942756
Name:CANTWELL, JOSEPH B (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:B
Last Name:CANTWELL
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 1:112 SCHOOL LN
Mailing Address - Street 2:
Mailing Address - City:TELFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18969-2043
Mailing Address - Country:US
Mailing Address - Phone:215-721-3998
Mailing Address - Fax:215-721-3990
Practice Address - Street 1:112 SCHOOL LN
Practice Address - Street 2:
Practice Address - City:TELFORD
Practice Address - State:PA
Practice Address - Zip Code:18969-2043
Practice Address - Country:US
Practice Address - Phone:215-721-3998
Practice Address - Fax:215-721-3990
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009367111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAV05296Medicare UPIN
PA091647Medicare ID - Type Unspecified