Provider Demographics
NPI:1093725509
Name:GETTY, SAMUEL FRAZER (DC)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:FRAZER
Last Name:GETTY
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 1:542 BRIDGE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17070-1957
Mailing Address - Country:US
Mailing Address - Phone:717-561-9988
Mailing Address - Fax:717-909-5982
Practice Address - Street 1:542 BRIDGE ST
Practice Address - Street 2:SUITE A
Practice Address - City:NEW CUMBERLAND
Practice Address - State:PA
Practice Address - Zip Code:17070-1957
Practice Address - Country:US
Practice Address - Phone:717-561-9988
Practice Address - Fax:717-909-5982
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002651L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T30484Medicare UPIN
PAGE447076Medicare ID - Type Unspecified