Provider Demographics
NPI:1891782801
Name:MAGLIENTE, SAMUEL JOSEPH (DC)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:JOSEPH
Last Name:MAGLIENTE
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 1:1402 DAWS RD
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-3601
Mailing Address - Country:US
Mailing Address - Phone:610-277-5533
Mailing Address - Fax:610-277-9810
Practice Address - Street 1:1402 DAWS RD
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-3601
Practice Address - Country:US
Practice Address - Phone:610-277-5533
Practice Address - Fax:610-277-9810
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002416L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T30569Medicare UPIN
PA462689Medicare ID - Type Unspecified