Provider Demographics
NPI:1023093002
Name:HOUTZ, DEREK A (DC)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:A
Last Name:HOUTZ
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 1:19 N. MARKET ST
Mailing Address - Street 2:
Mailing Address - City:MCVEYTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17051
Mailing Address - Country:US
Mailing Address - Phone:717-899-5686
Mailing Address - Fax:717-899-7044
Practice Address - Street 1:19 N. MARKET ST
Practice Address - Street 2:
Practice Address - City:MCVEYTOWN
Practice Address - State:PA
Practice Address - Zip Code:17051
Practice Address - Country:US
Practice Address - Phone:717-899-5686
Practice Address - Fax:717-899-7044
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007457L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017382520002Medicaid
PA024813Medicare ID - Type Unspecified
PA0017382520002Medicaid