Provider Demographics
NPI:1073599247
Name:LANDIAK, PAUL JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOSEPH
Last Name:LANDIAK
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 1:773 ALMOND RD
Mailing Address - Street 2:
Mailing Address - City:WALNUTPORT
Mailing Address - State:PA
Mailing Address - Zip Code:18088-9753
Mailing Address - Country:US
Mailing Address - Phone:610-767-5002
Mailing Address - Fax:610-767-5002
Practice Address - Street 1:773 ALMOND RD
Practice Address - Street 2:
Practice Address - City:WALNUTPORT
Practice Address - State:PA
Practice Address - Zip Code:18088-9753
Practice Address - Country:US
Practice Address - Phone:610-767-5002
Practice Address - Fax:610-767-5002
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001172L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1427738OtherBLUE SHIELD
T29116Medicare UPIN
LA1427738OtherBLUE SHIELD