Provider Demographics
NPI:1215925300
Name:WITHUM, LAWRENCE T (DC)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:T
Last Name:WITHUM
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 1:1516 LITITZ PIKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-6506
Mailing Address - Country:US
Mailing Address - Phone:717-397-5810
Mailing Address - Fax:717-397-0276
Practice Address - Street 1:1516 LITITZ PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6506
Practice Address - Country:US
Practice Address - Phone:717-397-5810
Practice Address - Fax:717-397-0276
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004222L111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011930370001Medicaid
PA0011930370001Medicaid
585034F70Medicare PIN