Provider Demographics
NPI:1922561257
Name:CITYWIDE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CITYWIDE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DIBARTOLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-469-5000
Mailing Address - Street 1:1 DORATO DR
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-7504
Mailing Address - Country:US
Mailing Address - Phone:609-335-1093
Mailing Address - Fax:
Practice Address - Street 1:7028 TERMINAL SQ
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-2341
Practice Address - Country:US
Practice Address - Phone:215-469-5000
Practice Address - Fax:215-469-5001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty