Provider Demographics
NPI:1013198308
Name:WILMINGTON PIKE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:WILMINGTON PIKE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-433-5154
Mailing Address - Street 1:4770 WILMINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45440-2021
Mailing Address - Country:US
Mailing Address - Phone:937-433-5154
Mailing Address - Fax:937-433-2884
Practice Address - Street 1:4770 WILMINGTON PIKE
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45440-2021
Practice Address - Country:US
Practice Address - Phone:937-433-5154
Practice Address - Fax:937-433-2884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2108111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4490200OtherUHC
OH000000020117OtherBC/BS
OH000000364432OtherANTHEM
OH0460040Medicaid
OH4490200OtherUHC
OH0460040Medicaid