1366740441 NPI number — WILKES BARRE CHIROPRACTIC AND REHABILITITION INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366740441 NPI number — WILKES BARRE CHIROPRACTIC AND REHABILITITION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILKES BARRE CHIROPRACTIC AND REHABILITITION INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366740441
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
380 OLD RIVER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILKES BARRE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18702-1561
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-825-5535
Provider Business Mailing Address Fax Number:
570-825-5536

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
380 OLD RIVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILKES BARRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18702-1561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-825-5535
Provider Business Practice Location Address Fax Number:
570-825-5536
Provider Enumeration Date:
03/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LEWIS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
BRUCE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
570-606-9707

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC004442L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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