Provider Demographics
NPI:1275545410
Name:ORIMENKO, MARTIN P (DC)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:P
Last Name:ORIMENKO
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 1:16 E LANCASTER AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2228
Mailing Address - Country:US
Mailing Address - Phone:610-896-1554
Mailing Address - Fax:
Practice Address - Street 1:16 E LANCASTER AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-2228
Practice Address - Country:US
Practice Address - Phone:610-896-1554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 28834111N00000X
PADC010174111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor