Provider Demographics
NPI:1124474952
Name:WELLNESS CHIROPRACTIC CENTER AT SOUTHPOINTE
Entity type:Organization
Organization Name:WELLNESS CHIROPRACTIC CENTER AT SOUTHPOINTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GENO
Authorized Official - Middle Name:
Authorized Official - Last Name:PISCIOTTANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-743-4500
Mailing Address - Street 1:300 CEDAR HILL DR
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2529
Mailing Address - Country:US
Mailing Address - Phone:724-743-4500
Mailing Address - Fax:724-743-4501
Practice Address - Street 1:300 CEDAR HILL DR
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2529
Practice Address - Country:US
Practice Address - Phone:724-743-4500
Practice Address - Fax:724-743-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006881L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA093291Medicare PIN