Provider Demographics
NPI:1033492624
Name:WANNINGER CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:WANNINGER CHIROPRACTIC, LLC
Other - Org Name:BEYOND WELLNESS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WANNINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-622-4630
Mailing Address - Street 1:3069 MAYBANK HWY
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-4873
Mailing Address - Country:US
Mailing Address - Phone:843-628-5353
Mailing Address - Fax:
Practice Address - Street 1:3069 MAYBANK HWY
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-4873
Practice Address - Country:US
Practice Address - Phone:843-628-5353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty