1972673291 NPI number — WYNNE CHIROPRACTIC CTR PA

Table of content: (NPI 1972673291)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972673291 NPI number — WYNNE CHIROPRACTIC CTR PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WYNNE CHIROPRACTIC CTR PA
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:
1972673291
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3420A WRIGHTSVILLE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28403-4118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-799-2225
Provider Business Mailing Address Fax Number:
910-799-6612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3420A WRIGHTSVILLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28403-4118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-799-2225
Provider Business Practice Location Address Fax Number:
910-799-6612
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WYNNE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
KEVIN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
910-799-2225

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 08946 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8908946 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com