Provider Demographics
NPI:1023197365
Name:KRASHNAK, ANDREW JOSEPH III (DC DACRB CCN DACBN)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JOSEPH
Last Name:KRASHNAK
Suffix:III
Gender:M
Credentials:DC DACRB CCN DACBN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:42 E MAIN ST
Mailing Address - City:PLYMOUTH
Mailing Address - State:PA
Mailing Address - Zip Code:18651-0159
Mailing Address - Country:US
Mailing Address - Phone:570-779-4434
Mailing Address - Fax:570-779-4439
Practice Address - Street 1:42 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:PA
Practice Address - Zip Code:18651-0159
Practice Address - Country:US
Practice Address - Phone:570-779-4434
Practice Address - Fax:570-779-4439
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC4421L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015118010006Medicaid
1031983OtherCAPITAL BC
2304812OtherAETN
358173OtherHEALTH ASSURANCE
PAKR568897OtherBCBS
2304220OtherAETN
5681573OtherFIRST HEALTH
PA1525891OtherGATEWAY
PAKR568897OtherBCBS
2304220OtherAETN