Provider Demographics
NPI:1518431998
Name:RESTORATION SPINE AND WELLNESS LLC
Entity Type:Organization
Organization Name:RESTORATION SPINE AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEMMO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-547-6844
Mailing Address - Street 1:120 W GERMANTOWN PIKE STE 210
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1420
Mailing Address - Country:US
Mailing Address - Phone:610-828-9634
Mailing Address - Fax:610-828-9762
Practice Address - Street 1:120 W GERMANTOWN PIKE STE 210
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1420
Practice Address - Country:US
Practice Address - Phone:610-828-9634
Practice Address - Fax:610-828-9762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty