Active NPI
Mark Cavallo, DC
- Chiropractor
- East Norriton, PA
National Provider Identifier
1619917549
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- DC3721L
- Practice address
- 304 West Johnson Hwy
East Norriton, PA 19401 - Phone
- (484) 808-8888
- Fax
- (484) 808-8890
- NPI assigned
- Jun 8, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC3721L | PA | Primary |
Addresses
Primary practice location
304 West Johnson Hwy
East Norriton, PA 19401
Mailing address
304 West Johnson Highway
East Norriton, PA 19401
Phone (484) 808-8888
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 071294835 | Medicaid | PA | |
| 0083207000 | Other | PA | PA BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DC3721L | PA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149724800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317168000000",
"number": "1619917549",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "304 WEST JOHNSON HIGHWAY",
"city": "EAST NORRITON",
"state": "PA",
"postal_code": "19401",
"telephone_number": "484-808-8888",
"fax_number": "484-808-8890"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "304 WEST JOHNSON HWY",
"city": "EAST NORRITON",
"state": "PA",
"postal_code": "19401",
"telephone_number": "484-808-8888",
"fax_number": "484-808-8890"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAVALLO",
"first_name": "MARK",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-08",
"last_updated": "2011-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "PA",
"license": "DC3721L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "071294835",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PA BLUE SHIELD",
"identifier": "0083207000",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in East Norriton, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.