Healthcare Provider Details

I. General information

NPI: 1316936602
Provider Name (Legal Business Name): WISE CHIROPRACTIC & REHABILITATION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 W MAIN ST
LOCK HAVEN PA
17745-1243
US

IV. Provider business mailing address

5 W MAIN ST
LOCK HAVEN PA
17745-1243
US

V. Phone/Fax

Practice location:
  • Phone: 570-748-7462
  • Fax: 570-748-8910
Mailing address:
  • Phone: 570-748-7462
  • Fax: 570-748-8910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: VON WISE
Title or Position: OWNER PT
Credential: DC
Phone: 570-748-7462