MEDICARE: DR. ANDREW ALBIN WAITKEVICH D.C

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	DC009868	PA

General Provider Information

NPI Number	:	1972786499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW ALBIN WAITKEVICH D.C

Provider Business Mailing Address
First Line	:	9251 ROOSEVELT BLVD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-2205
Country	:	US
Telephone Number	:	215-969-2424
Fax Number	:	215-464-6923

Provider Business Practice Location Address
First Line	:	4055 RIDGE AVE APT 4707
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1587
Country	:	US
Telephone Number	:	508-873-5010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2007
Last Update Date	:	06/13/2016

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