Provider Demographics
NPI:1720150295
Name:SPADAFORA, CHRISTINE MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:MARIE
Last Name:SPADAFORA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CHRISTINE
Other - Middle Name:MARIE
Other - Last Name:EMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1040 MILLCREEK DR
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-7321
Mailing Address - Country:US
Mailing Address - Phone:267-684-6123
Mailing Address - Fax:267-684-6417
Practice Address - Street 1:1040 MILLCREEK DR
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-7321
Practice Address - Country:US
Practice Address - Phone:267-684-6123
Practice Address - Fax:267-684-6417
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004566L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001454008Medicaid
PAU10948Medicare UPIN
PA649984N2GMedicare ID - Type Unspecified