Provider Demographics
NPI:1881687523
Name:WITMER, ALICIA VIRGA (DC)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:VIRGA
Last Name:WITMER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LAWN
Mailing Address - State:PA
Mailing Address - Zip Code:19609-1648
Mailing Address - Country:US
Mailing Address - Phone:610-670-8550
Mailing Address - Fax:
Practice Address - Street 1:2112 PENN AVE
Practice Address - Street 2:
Practice Address - City:WEST LAWN
Practice Address - State:PA
Practice Address - Zip Code:19609-1648
Practice Address - Country:US
Practice Address - Phone:610-670-8550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005830L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U55811Medicare UPIN
PAWI652336Medicare ID - Type Unspecified