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General NPI Number Information
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NPI Number | 1235429929
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Entity Type | Organization
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Legal Business Name | WHEELING SPINE CENTER AND MASSAGE LLC
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Dates
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Enumeration Date | 04/14/2011
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Last Update Date | 04/14/2011
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Provider Practice Location Address
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Address Line | 3169 MAIN ST
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City | WEIRTON
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State | WV
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Zip | 26062-4711
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Country | US
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Telephone | 740-266-4908
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Fax | 740-264-4376
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Provider Business Mailing Address
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Address Line | 1140 MAIN ST SUITE 100
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City | WHEELING
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State | WV
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Zip | 26003-2742
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Country | US
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Telephone | 740-266-4908
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Fax | 740-264-4376
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Authorized Official
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Title or Position | MEMBER
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Name | SANTE A RULLI
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Credential | DC
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Telephone | 740-266-4908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 885
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License Number State | WV
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