Provider Demographics
NPI:1356343362
Name:CANTY, CATHERINE E (DC)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:E
Last Name:CANTY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8012 PINE ROAD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111
Mailing Address - Country:US
Mailing Address - Phone:215-342-6004
Mailing Address - Fax:215-342-6005
Practice Address - Street 1:8012 PINE ROAD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111
Practice Address - Country:US
Practice Address - Phone:215-342-6004
Practice Address - Fax:215-342-6005
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003860L111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016210350003Medicaid
PA0016210350003Medicaid
PA24387Medicare UPIN