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General NPI Number Information
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NPI Number | 1669648846
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Entity Type | Organization
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Legal Business Name | WANAMAKER CHIROPRACTIC
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Dates
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Enumeration Date | 05/07/2008
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Last Update Date | 05/07/2008
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Provider Practice Location Address
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Address Line | 12765 S SAGINAW ST STE 403
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City | GRAND BLANC
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State | MI
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Zip | 48439-2450
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Country | US
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Telephone | 810-695-9864
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Fax | 810-695-1071
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Provider Business Mailing Address
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Address Line | 12765 S SAGINAW ST STE 403
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City | GRAND BLANC
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State | MI
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Zip | 48439-2450
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Country | US
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Telephone | 810-695-9864
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Fax | 810-695-1071
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. GARY WANAMAKER
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Credential | D.C.
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Telephone | 810-694-9864
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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 |
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License Number State |
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