Provider Demographics
NPI:1437398484
Name:WAITKEVICH CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:WAITKEVICH CHIROPRACTIC, LLC
Other - Org Name:ANDREW WAITKEVICH, D.C
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:ALBIN
Authorized Official - Last Name:WAITKEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-873-5010
Mailing Address - Street 1:9251 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-2205
Mailing Address - Country:US
Mailing Address - Phone:215-969-2424
Mailing Address - Fax:
Practice Address - Street 1:9251 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114
Practice Address - Country:US
Practice Address - Phone:215-969-2424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-16
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009868111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty