Provider Demographics
NPI:1346399128
Name:VITKO, ANDREW PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:PETER
Last Name:VITKO
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 1:466 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2338
Mailing Address - Country:US
Mailing Address - Phone:330-722-6684
Mailing Address - Fax:
Practice Address - Street 1:466 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2338
Practice Address - Country:US
Practice Address - Phone:330-722-6684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000115469OtherANTHEM BC BS
OH000000115469OtherANTHEM BC BS