MEDICARE: DOUGLAS P LICHTINGER DC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC007173L	PA

General Provider Information

NPI Number	:	1508821687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOUGLAS P LICHTINGER DC INC

Provider Business Mailing Address
First Line	:	PO BOX 239
Second Line	:
City	:	WATERFORD
State	:	PA
Zip	:	16441
Country	:	US
Telephone Number	:	814-796-9161
Fax Number	:	814-796-1121

Provider Business Practice Location Address
First Line	:	212 HIGH STREET
Second Line	:
City	:	WATERFORD
State	:	PA
Zip	:	16441
Country	:	US
Telephone Number	:	814-796-9161
Fax Number	:	814-796-1121

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	DOUGLAS PAUL LICHTINGER
Credential	:	DC
Telephone Number	:	814-796-9161

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	09/20/2007

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