Provider Demographics
NPI:1619957859
Name:CARFELLO, DOMINICK GREGORY (DC)
Entity Type:Individual
Prefix:DR
First Name:DOMINICK
Middle Name:GREGORY
Last Name:CARFELLO
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 1:2 WENDOVER DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3326
Mailing Address - Country:US
Mailing Address - Phone:856-231-9008
Mailing Address - Fax:215-925-4821
Practice Address - Street 1:520 N COLUMBUS BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-4226
Practice Address - Country:US
Practice Address - Phone:215-239-3097
Practice Address - Fax:215-239-3098
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-21
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-2363-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA195231Medicare ID - Type UnspecifiedCHIROPRACTOR