Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC004222L | PA |
N | 111NS0005X | Chiropractic Sports Physician | DC004222L | PA |
NPI | 1215925300 |
---|---|
Provider Name | Dr. Lawrence T Withum |
First Address | Lancaster, PA 17601-6506 |
Second Address | Lancaster, PA 17601-6506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 28/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0011930370001 | (05) | PA |
T90323 | (02) |