Provider Demographics
NPI:1194863308
Name:RAYMOND C. WISNIEWSKI, D.C.
Entity Type:Organization
Organization Name:RAYMOND C. WISNIEWSKI, D.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:WISNIEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:412-242-1600
Mailing Address - Street 1:10483 FRANKSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-2917
Mailing Address - Country:US
Mailing Address - Phone:412-242-1600
Mailing Address - Fax:412-241-5230
Practice Address - Street 1:10483 FRANKSTOWN RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-2917
Practice Address - Country:US
Practice Address - Phone:412-242-1600
Practice Address - Fax:412-241-5230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-002553-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000890816-0002Medicaid
PAT30144Medicare UPIN
PA000890816-0002Medicaid