Provider Demographics
NPI:1548444607
Name:CARDONICK CHIROPRACTIC PC
Entity type:Organization
Organization Name:CARDONICK CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:CARDONICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-242-8632
Mailing Address - Street 1:23 EAST DURHAM STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-1821
Mailing Address - Country:US
Mailing Address - Phone:215-242-8632
Mailing Address - Fax:215-242-4226
Practice Address - Street 1:23 EAST DURHAM ST.
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-1821
Practice Address - Country:US
Practice Address - Phone:215-242-8632
Practice Address - Fax:215-242-4226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYDC5192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0527913OtherAETNA
PA0237787000OtherPERSONAL CHOICE
PA0237787000OtherPERSONAL CHOICE