Provider Demographics
NPI:1881844801
Name:PANDOLFO CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:PANDOLFO CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PANDOLFO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-622-4888
Mailing Address - Street 1:3434 GARRETT RD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-2941
Mailing Address - Country:US
Mailing Address - Phone:610-622-4888
Mailing Address - Fax:
Practice Address - Street 1:3434 GARRETT RD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-2941
Practice Address - Country:US
Practice Address - Phone:610-622-4888
Practice Address - Fax:610-622-4885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA198943Medicare PIN