Provider Demographics
NPI:1033101910
Name:ITKIN, OLGA (DC)
Entity Type:Individual
Prefix:DR
First Name:OLGA
Middle Name:
Last Name:ITKIN
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 1:14425 BUSTLETON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19116-1177
Mailing Address - Country:US
Mailing Address - Phone:215-676-3236
Mailing Address - Fax:
Practice Address - Street 1:14425 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19116-1177
Practice Address - Country:US
Practice Address - Phone:215-676-3236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006252L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01530727Medicaid
PAIT779560Medicare ID - Type Unspecified
PA01530727Medicaid