Provider Demographics
NPI:1477763308
Name:TANCREDI CHIROPRACTIC & REHABILITATION CENTER P C
Entity Type:Organization
Organization Name:TANCREDI CHIROPRACTIC & REHABILITATION CENTER P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:TANCREDI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-353-9400
Mailing Address - Street 1:600 REED RD
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3505
Mailing Address - Country:US
Mailing Address - Phone:610-353-9400
Mailing Address - Fax:610-353-2280
Practice Address - Street 1:600 REED RD
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3505
Practice Address - Country:US
Practice Address - Phone:610-353-9400
Practice Address - Fax:610-353-2280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003716L111NS0005X
PAPT013686L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0451646HYMedicare ID - Type Unspecified
PAT29587Medicare UPIN
PA145656UHYMedicare ID - Type Unspecified