Tri-State Sport and Spine, PLLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC010688 Issued in PA

Legal business name

TRI-STATE SPORT AND SPINE, PLLC

Practice address

9331 Old Bustleton Ave
Suite 101
Philadelphia, PA 19115-4204

Phone

(215) 251-8526

Fax

(215) 673-1980

NPI assigned

Oct 21, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Michael R Dougherty, DC

Title

President

Phone

(215) 251-8526

Specialties & licenses 1

Addresses

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Tri-State Sport and Spine, PLLC

  • Chiropractor
  • Philadelphia, PA
  • NPI 1578921359
  NPPES parent name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1413849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413849600000",
    "number": "1902200876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 WHARTON ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191475425",
            "telephone_number": "215-251-8526",
            "fax_number": "215-673-1980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9331 OLD BUSTLETON AVE",
            "address_2": "SUITE 101",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191154204",
            "telephone_number": "215-251-8526",
            "fax_number": "215-673-1980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-STATE SPORT AND SPINE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-21",
        "last_updated": "2014-10-21",
        "status": "A",
        "authorized_official_last_name": "DOUGHERTY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "215-251-8526",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "DC010688",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tri-County Home Healthcare, LLC
• Tri-County Home Support Services LLC
• Tri-State Cardiovascular Imaging Associates, Inc.
• Tri-State Eye Assoc.
• Tri-State Sport and Spine, PLLC
• Tri-Tech Health PA, LLC
• Austin James Triana, MD
• Lauren Triana, M.A. CCC-SLP
• Triangle Medical, Inc.
• Charles Tribe

• Chiropractor in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Chiropractor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.