Basic Information
| Provider Information | |||||||||
| NPI: | 1720242290 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEXFORD WELLNESS CHIROPRACTIC, ACUPUNCTURE, REHAB, & ENERGY INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2630 BRANDT SCHOOL RD | ||||||||
| Address2: | SUITE 5 FRANKLIN VILLAGE | ||||||||
| City: | WEXFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150907646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249354300 | ||||||||
| FaxNumber: | 7249354321 | ||||||||
| Practice Location | |||||||||
| Address1: | 2630 BRANDT SCHOOL RD | ||||||||
| Address2: | SUITE 5 FRANKLIN VILLAGE | ||||||||
| City: | WEXFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150907646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249354300 | ||||||||
| FaxNumber: | 7249354321 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2008 | ||||||||
| LastUpdateDate: | 07/15/2008 | ||||||||
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| AuthorizedOfficialLastName: | MILLEN | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/CEO | ||||||||
| AuthorizedOfficialTelephone: | 7244542122 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | DC007821L | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.