Provider Demographics
NPI:1669164729
Name:SHVIDKO, VLADISLAV (DC)
Entity type:Individual
Prefix:DR
First Name:VLADISLAV
Middle Name:
Last Name:SHVIDKO
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 1:1392 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-3231
Mailing Address - Country:US
Mailing Address - Phone:724-342-2225
Mailing Address - Fax:724-204-1708
Practice Address - Street 1:1392 E STATE ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:PA
Practice Address - Zip Code:16146-3231
Practice Address - Country:US
Practice Address - Phone:724-342-2225
Practice Address - Fax:724-204-1708
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011796111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty