Provider Demographics
NPI:1235136110
Name:LOTMAN, KEVIN MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:LOTMAN
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:PO BOX 420
Mailing Address - Street 2:
Mailing Address - City:BRIER HILL
Mailing Address - State:PA
Mailing Address - Zip Code:15415-0420
Mailing Address - Country:US
Mailing Address - Phone:724-785-2270
Mailing Address - Fax:724-785-2270
Practice Address - Street 1:6367 NATIONAL PIKE
Practice Address - Street 2:
Practice Address - City:GRINDSTONE
Practice Address - State:PA
Practice Address - Zip Code:15442-1114
Practice Address - Country:US
Practice Address - Phone:724-785-2270
Practice Address - Fax:724-785-2270
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002650-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
L0446469Medicare ID - Type Unspecified