Provider Demographics
NPI:1891813259
Name:GENOVESI, EDWARD A (DC)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:A
Last Name:GENOVESI
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 1:6932 TORRESDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19135-1906
Mailing Address - Country:US
Mailing Address - Phone:215-338-8840
Mailing Address - Fax:215-338-8841
Practice Address - Street 1:6932 TORRESDALE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-1906
Practice Address - Country:US
Practice Address - Phone:215-338-8840
Practice Address - Fax:215-338-8841
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007523L111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation