Provider Demographics
NPI:1134231699
Name:GOTTLIEB, ANDREW E (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:E
Last Name:GOTTLIEB
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:PO BOX 795
Mailing Address - Street 2:
Mailing Address - City:UWCHLAND
Mailing Address - State:PA
Mailing Address - Zip Code:19480
Mailing Address - Country:US
Mailing Address - Phone:610-458-7777
Mailing Address - Fax:610-458-7908
Practice Address - Street 1:30 N VILLAGE AVE
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1211
Practice Address - Country:US
Practice Address - Phone:610-458-7777
Practice Address - Fax:610-458-7908
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004743L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00139115004Medicaid
PA5931123OtherAETNA PPO
PA0508527000OtherKEYSTONE HEALTH PLAN EAST
PA5931123OtherAETNA PPO
PA0508527000OtherKEYSTONE HEALTH PLAN EAST