1952461683 NPI number — WESTSIDE WELLNESS CHIROPRACTIC CENTER

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 1952461683 NPI number — WESTSIDE WELLNESS CHIROPRACTIC CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTSIDE WELLNESS CHIROPRACTIC CENTER
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:
1952461683
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
230 SUGARTOWN RD
Provider Second Line Business Mailing Address:
SUITE 60
Provider Business Mailing Address City Name:
WAYNE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19087-6003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
230 SUGARTOWN RD
Provider Second Line Business Practice Location Address:
SUITE 60
Provider Business Practice Location Address City Name:
WAYNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19087-3029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-687-8988
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SERINSKY
Authorized Official First Name:
TODD
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
610-687-8988

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC009341 , 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)

  • Identifier: 2400364000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1695784 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7531628 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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