Provider Demographics
NPI:1275617292
Name:RESNICK, RAYMOND LEWIS (DC)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:LEWIS
Last Name:RESNICK
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 1:305 N POTTSTOWN PIKE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2242
Mailing Address - Country:US
Mailing Address - Phone:610-363-7625
Mailing Address - Fax:610-363-7957
Practice Address - Street 1:305 N POTTSTOWN PIKE
Practice Address - Street 2:SUITE 206
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2242
Practice Address - Country:US
Practice Address - Phone:610-363-7625
Practice Address - Fax:610-363-7957
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003715L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARE690221Medicare ID - Type Unspecified
PAU24493Medicare UPIN