Provider Demographics
NPI:1912198060
Name:DELAWARE VALLEY CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:DELAWARE VALLEY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:COLANTUONI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-666-7400
Mailing Address - Street 1:2812 EGYPT ROAD
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:PA
Mailing Address - Zip Code:19403-2195
Mailing Address - Country:US
Mailing Address - Phone:610-666-7400
Mailing Address - Fax:610-666-7558
Practice Address - Street 1:2812 EGYPT ROAD
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:PA
Practice Address - Zip Code:19403-2195
Practice Address - Country:US
Practice Address - Phone:610-666-7400
Practice Address - Fax:610-666-7558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002744L261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA416562Medicare PIN