Provider Demographics
NPI:1013042324
Name:KYTCHAK, DAVID ALLEN (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALLEN
Last Name:KYTCHAK
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 1:418 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-1773
Mailing Address - Country:US
Mailing Address - Phone:724-588-7550
Mailing Address - Fax:724-588-1788
Practice Address - Street 1:418 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-1773
Practice Address - Country:US
Practice Address - Phone:724-588-7550
Practice Address - Fax:724-588-1788
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005887L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA216200OtherUPMC
PA0001509133Medicaid
PAU51879Medicare UPIN
PA0001509133Medicaid