Provider Demographics
NPI:1659462364
Name:C.A.F.E. OF LIFE CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:C.A.F.E. OF LIFE CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFONSO
Authorized Official - Middle Name:
Authorized Official - Last Name:DI CARLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-366-1336
Mailing Address - Street 1:4540 HAMILTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6195
Mailing Address - Country:US
Mailing Address - Phone:610-366-1336
Mailing Address - Fax:610-366-1397
Practice Address - Street 1:4540 HAMILTON BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6195
Practice Address - Country:US
Practice Address - Phone:610-366-1336
Practice Address - Fax:610-366-1397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007846-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU825115Medicare UPIN
PA043389Medicare ID - Type UnspecifiedMEDICARE