Provider Demographics
NPI:1972786499
Name:WAITKEVICH, ANDREW ALBIN (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:ALBIN
Last Name:WAITKEVICH
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 1:9251 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:215-464-6923
Practice Address - Street 1:4055 RIDGE AVE APT 4707
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19129-1587
Practice Address - Country:US
Practice Address - Phone:508-873-5010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009868111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor