MEDICARE: WYOMING VALLEY CHIROPRACTIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC002138L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	WY1640137	OTHER		BLUE SHIELD

General Provider Information

NPI Number	:	1598750267
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WYOMING VALLEY CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	1247 WYOMING AVE
Second Line	:
City	:	FORTY FORT
State	:	PA
Zip	:	18704-4101
Country	:	US
Telephone Number	:	570-288-9998
Fax Number	:	570-288-8430

Provider Business Practice Location Address
First Line	:	1247 WYOMING AVE
Second Line	:
City	:	FORTY FORT
State	:	PA
Zip	:	18704-4101
Country	:	US
Telephone Number	:	570-288-9998
Fax Number	:	570-288-8430

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LOUIS JOHN GUARNIERI
Credential	:	DC
Telephone Number	:	570-288-9998

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	07/21/2009

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Directions to “WYOMING VALLEY CHIROPRACTIC INC ” Practice Location

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