Provider Demographics
NPI:1821303017
Name:POWELL, TASHA SHALEKA
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:SHALEKA
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 NORTH 3RD ST.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123
Mailing Address - Country:US
Mailing Address - Phone:215-964-9947
Mailing Address - Fax:215-964-9655
Practice Address - Street 1:836 NORTH 3RD ST
Practice Address - Street 2:SUITE 2
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123
Practice Address - Country:US
Practice Address - Phone:215-964-9947
Practice Address - Fax:215-964-9655
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010296111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor