Provider Demographics
NPI:1083829121
Name:LAUDERMILCH, EDWIN R (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:R
Last Name:LAUDERMILCH
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 1:77 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-1419
Mailing Address - Country:US
Mailing Address - Phone:717-533-4844
Mailing Address - Fax:717-533-5285
Practice Address - Street 1:75 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-1419
Practice Address - Country:US
Practice Address - Phone:717-533-4844
Practice Address - Fax:717-533-5285
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2018-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002069L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA025565TGQMedicare ID - Type Unspecified
PAT27135Medicare UPIN
063851Medicare ID - Type Unspecified