Provider Demographics
NPI:1841310257
Name:PETROSKY CHIROPRACTIC & REHABILITATION, LLC
Entity type:Organization
Organization Name:PETROSKY CHIROPRACTIC & REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:PETROSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-366-2085
Mailing Address - Street 1:813 N PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-2021
Mailing Address - Country:US
Mailing Address - Phone:215-366-2085
Mailing Address - Fax:215-860-1976
Practice Address - Street 1:638 NEWTOWN YARDLEY RD
Practice Address - Street 2:SUITE 2E
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1758
Practice Address - Country:US
Practice Address - Phone:215-968-1711
Practice Address - Fax:215-860-1976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty