Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC010207 | PA |
NPI | 1003138686 |
---|---|
Provider Name | Dr. Sean Pham |
First Address | Philadelphia, PA 19147-4825 |
Second Address | Philadelphia, PA 19147-4825 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2010 |
Last Update Date | 07/12/2011 |