Provider Demographics
NPI:1790798957
Name:CASTOR, MICHAEL MARK SR (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MARK
Last Name:CASTOR
Suffix:SR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:301 OXFORD VALLEY RD
Mailing Address - Street 2:SUITE 1104
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-7706
Mailing Address - Country:US
Mailing Address - Phone:215-493-7504
Mailing Address - Fax:215-493-7591
Practice Address - Street 1:301 OXFORD VALLEY RD
Practice Address - Street 2:SUITE 1104
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-7706
Practice Address - Country:US
Practice Address - Phone:215-493-7504
Practice Address - Fax:215-493-7591
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADC002117L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA151480Medicare ID - Type Unspecified
PAT29670Medicare UPIN