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General NPI Number Information
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NPI Number | 1134434202
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Entity Type | Organization
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Legal Business Name | CHIC WIGS LLC
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Dates
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Enumeration Date | 08/13/2010
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Last Update Date | 09/18/2014
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Provider Practice Location Address
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Address Line | 5630 PEACH STR B-19
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City | ERIE
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State | PA
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Zip | 16565
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Country | US
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Telephone | 814-864-7454
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Fax | 814-864-7454
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Provider Business Mailing Address
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Address Line | 2180 MATHESON BLVD EAST. UNIT 1
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City | MISSISSAUGA
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State | ONTARIO
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Zip | L4W5E1
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Country | CA
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Telephone | 18663637768
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Fax | 18002657775
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MR. PETER MATTIUZZO
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Credential |
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Telephone | 905-206-5503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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