Provider Demographics
NPI:1710261631
Name:KETTERING, ANDREW R (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:R
Last Name:KETTERING
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 1:1601 COLUMBIA AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-4528
Mailing Address - Country:US
Mailing Address - Phone:717-509-6166
Mailing Address - Fax:
Practice Address - Street 1:1601 COLUMBIA AVE STE 102
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-4528
Practice Address - Country:US
Practice Address - Phone:717-509-6166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010494111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor