Provider Demographics
NPI:1013213909
Name:AUSTIN, ALICIA ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:ANN
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-1862
Mailing Address - Country:US
Mailing Address - Phone:814-331-4892
Mailing Address - Fax:
Practice Address - Street 1:536 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-1862
Practice Address - Country:US
Practice Address - Phone:814-331-4892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-10
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010527111N00000X
PAAJ010319111N00000X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program