Healthcare Provider Details

I. General information

NPI: 1366716672
Provider Name (Legal Business Name): CHIROPRACTIC AND WELLNESS WORKS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2012
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 N KERRWOOD DR SUITE 204
HERMITAGE PA
16148-5202
US

IV. Provider business mailing address

490 N KERRWOOD DR SUITE 204
HERMITAGE PA
16148-5202
US

V. Phone/Fax

Practice location:
  • Phone: 724-342-7778
  • Fax: 724-342-7373
Mailing address:
  • Phone: 724-342-7778
  • Fax: 724-342-7373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC010518
License Number StatePA

VIII. Authorized Official

Name: EUGENE MENNOW II
Title or Position: OWNER
Credential: DC
Phone: 724-342-7778