Provider Demographics
NPI:1568485654
Name:VACTOR, RAYMOND V (DC)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:V
Last Name:VACTOR
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 1:130 WEXFORD BAYNE RD
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8749
Mailing Address - Country:US
Mailing Address - Phone:724-935-1610
Mailing Address - Fax:724-935-2295
Practice Address - Street 1:130 WEXFORD BAYNE RD
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8749
Practice Address - Country:US
Practice Address - Phone:724-935-1610
Practice Address - Fax:724-935-2295
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004099L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001953800002Medicaid
PA001953800002Medicaid