Provider Demographics
NPI:1699822429
Name:MULDOON, ANNEMARIE (DC)
Entity Type:Individual
Prefix:
First Name:ANNEMARIE
Middle Name:
Last Name:MULDOON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6233 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19135-3404
Mailing Address - Country:US
Mailing Address - Phone:215-338-4132
Mailing Address - Fax:215-338-8898
Practice Address - Street 1:6233 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-3404
Practice Address - Country:US
Practice Address - Phone:215-338-4132
Practice Address - Fax:215-338-8898
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005012L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1088197OtherAETNA HMO
PA4572327OtherAETNA PPO
PA0964085000OtherPERSONAL CHOICE
PA1088197OtherAETNA HMO
PA4572327OtherAETNA PPO