Provider Demographics
NPI:1215962774
Name:WAHNER, BARRY A (DC)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:A
Last Name:WAHNER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4931 WISSAHICKON AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-4800
Mailing Address - Country:US
Mailing Address - Phone:215-842-2227
Mailing Address - Fax:215-842-2229
Practice Address - Street 1:4931 WISSAHICKON AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-4800
Practice Address - Country:US
Practice Address - Phone:215-842-2227
Practice Address - Fax:215-842-2229
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004737L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0526039000OtherKEYSTONE HEALTH PLAN EAST
PA1296428Medicaid
PA1296428Medicaid
U21745Medicare UPIN