Provider Demographics
NPI:1962525451
Name:RESICK, KATIE SUPIK (DC)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:SUPIK
Last Name:RESICK
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KATIE
Other - Middle Name:LYNN
Other - Last Name:SUPIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2876 MEADOW ST
Mailing Address - Street 2:
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-1818
Mailing Address - Country:US
Mailing Address - Phone:724-448-2281
Mailing Address - Fax:724-230-0259
Practice Address - Street 1:909 DALLAS AVE
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-2124
Practice Address - Country:US
Practice Address - Phone:724-448-2281
Practice Address - Fax:724-230-0259
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3216111N00000X
PADC009729111N00000X
FLCH9523111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor