Provider Demographics
NPI:1174721203
Name:SPEESLER, MICHAEL ANDREW
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANDREW
Last Name:SPEESLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 STRATHMORE DR
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-1722
Mailing Address - Country:US
Mailing Address - Phone:315-406-4720
Mailing Address - Fax:
Practice Address - Street 1:101 OLD YORK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3912
Practice Address - Country:US
Practice Address - Phone:215-877-5400
Practice Address - Fax:215-877-5401
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY70011505111N00000X
PADC009880111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor