Provider Demographics
NPI:1750443180
Name:MORMELLO, JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:MORMELLO
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 1:8919 NEW FALLS RD
Mailing Address - Street 2:SUITE 20
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19054-1713
Mailing Address - Country:US
Mailing Address - Phone:215-943-5706
Mailing Address - Fax:215-943-1044
Practice Address - Street 1:8919 NEW FALLS RD
Practice Address - Street 2:SUITE 20
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19054-1713
Practice Address - Country:US
Practice Address - Phone:215-943-5706
Practice Address - Fax:215-943-1044
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001380L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA107001Medicare ID - Type Unspecified