Provider Demographics
NPI:1558423988
Name:LIONVILLE CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:LIONVILLE CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:DUDDY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-594-8522
Mailing Address - Street 1:317 GORDON DR
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1201
Mailing Address - Country:US
Mailing Address - Phone:610-594-8522
Mailing Address - Fax:610-594-6499
Practice Address - Street 1:317 GORDON DR
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1201
Practice Address - Country:US
Practice Address - Phone:610-594-8522
Practice Address - Fax:610-594-6499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODC-006464-L111N00000X
NYDC-005947-L111N00000X
DC-004583-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0851162000OtherM. SEAN HURLEY, D.C.
PAL1965414OtherLIONVILLE CHIROPRACTIC
PA0431026000OtherLIONVILLE CHIROPRACTIC
PAU49338Medicare UPIN
PAHU821268Medicare ID - Type UnspecifiedM. SEAN HURLEY, D.C.
PAU72312Medicare UPIN
PAHU821268Medicare ID - Type UnspecifiedM. SEAN HURLEY, D.C.
PA0233920000OtherJERRY S. SANGIAMO, D.C.
PA0851162000OtherM. SEAN HURLEY, D.C.