Provider Demographics
NPI:1598833717
Name:JOSEPH, SAMUEL E (DC)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:E
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 DARBY RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-4608
Mailing Address - Country:US
Mailing Address - Phone:610-446-4808
Mailing Address - Fax:610-446-7020
Practice Address - Street 1:912 DARBY RD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-4608
Practice Address - Country:US
Practice Address - Phone:610-446-4808
Practice Address - Fax:610-446-7020
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2399L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT28275Medicare UPIN
PAJO81702Medicare ID - Type UnspecifiedMEDICAREBLUE CROSS