Provider Demographics
NPI:1295143303
Name:BRIDESBURG SPINE AND INJURY CLINIC LLC
Entity type:Organization
Organization Name:BRIDESBURG SPINE AND INJURY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:P
Authorized Official - Last Name:CALANTONI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-743-5330
Mailing Address - Street 1:2644 LEFEVRE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19137-1733
Mailing Address - Country:US
Mailing Address - Phone:215-743-5330
Mailing Address - Fax:215-941-6441
Practice Address - Street 1:2644 LEFEVRE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19137-1733
Practice Address - Country:US
Practice Address - Phone:215-743-5330
Practice Address - Fax:215-941-6441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-01
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009115111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA117559OtherINDIVIDUAL MC ID