Provider Demographics
NPI:1053356576
Name:WILLIAM M. TSOUBANOS, D.C.P.C.
Entity type:Organization
Organization Name:WILLIAM M. TSOUBANOS, D.C.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:TSOUBANOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-828-2500
Mailing Address - Street 1:6011 SHEAFF LN
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-1814
Mailing Address - Country:US
Mailing Address - Phone:610-476-9711
Mailing Address - Fax:
Practice Address - Street 1:815 FAYETTE ST
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1785
Practice Address - Country:US
Practice Address - Phone:610-828-2500
Practice Address - Fax:610-834-7822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002450L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty