Provider Demographics
NPI: | 1881844801 |
---|---|
Name: | PANDOLFO CHIROPRACTIC CENTER |
Entity Type: | Organization |
Organization Name: | PANDOLFO CHIROPRACTIC CENTER |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PROVIDER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JOHN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | PANDOLFO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 610-622-4888 |
Mailing Address - Street 1: | 3434 GARRETT RD |
Mailing Address - Street 2: | |
Mailing Address - City: | DREXEL HILL |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 19026-2941 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 610-622-4888 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3434 GARRETT RD |
Practice Address - Street 2: | |
Practice Address - City: | DREXEL HILL |
Practice Address - State: | PA |
Practice Address - Zip Code: | 19026-2941 |
Practice Address - Country: | US |
Practice Address - Phone: | 610-622-4888 |
Practice Address - Fax: | 610-622-4885 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-09-26 |
Last Update Date: | 2008-09-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 198943 | Medicare PIN |