Provider Demographics
NPI:1508821687
Name:DOUGLAS P LICHTINGER DC INC
Entity Type:Organization
Organization Name:DOUGLAS P LICHTINGER DC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:LICHTINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-796-9161
Mailing Address - Street 1:PO BOX 239
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16441
Mailing Address - Country:US
Mailing Address - Phone:814-796-9161
Mailing Address - Fax:814-796-1121
Practice Address - Street 1:212 HIGH STREET
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:PA
Practice Address - Zip Code:16441
Practice Address - Country:US
Practice Address - Phone:814-796-9161
Practice Address - Fax:814-796-1121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007173L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PALI005497Medicare ID - Type Unspecified