Provider Demographics
NPI:1013015742
Name:PAVKOV, LUKE T (DC)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:T
Last Name:PAVKOV
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 1:18 N PARK ROW
Mailing Address - Street 2:P.O. BOX 77
Mailing Address - City:WATERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16441-8308
Mailing Address - Country:US
Mailing Address - Phone:814-796-3300
Mailing Address - Fax:
Practice Address - Street 1:18 N PARK ROW
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:PA
Practice Address - Zip Code:16441-8308
Practice Address - Country:US
Practice Address - Phone:814-796-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009186111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor