Provider Demographics
NPI:1255487575
Name:PAMER, ANDREW L (DC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:L
Last Name:PAMER
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 1:9070 PEACH ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:WATERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16441-4022
Mailing Address - Country:US
Mailing Address - Phone:814-866-1933
Mailing Address - Fax:814-866-1934
Practice Address - Street 1:9070 PEACH ST
Practice Address - Street 2:SUITE #1
Practice Address - City:WATERFORD
Practice Address - State:PA
Practice Address - Zip Code:16441-4022
Practice Address - Country:US
Practice Address - Phone:814-866-1933
Practice Address - Fax:814-866-1934
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC8650111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001467638OtherHIGHMARK BLUECROSS
PA1014200490001Medicaid
PA1014200490001Medicaid