Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC009186 | PA |
NPI | 1013015742 |
---|---|
Provider Name | Dr. Luke T Pavkov |
First Address | Waterford, PA 16441-8308 |
Second Address | Waterford, PA 16441-8308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |