Provider Demographics
NPI:1053865618
Name:PERVAIZ, WAQAS (DC)
Entity Type:Individual
Prefix:DR
First Name:WAQAS
Middle Name:
Last Name:PERVAIZ
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 1:10 BLACKSMITH DR STE 1
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-4428
Mailing Address - Country:US
Mailing Address - Phone:518-289-5229
Mailing Address - Fax:518-400-1402
Practice Address - Street 1:10 BLACKSMITH DR STE 1
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-4428
Practice Address - Country:US
Practice Address - Phone:518-289-5229
Practice Address - Fax:518-400-1402
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012859-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY82-1829168OtherTAX ID