Provider Demographics
NPI:1235429929
Name:WHEELING SPINE CENTER AND MASSAGE LLC
Entity Type:Organization
Organization Name:WHEELING SPINE CENTER AND MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SANTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:RULLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-266-4908
Mailing Address - Street 1:1140 MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-2742
Mailing Address - Country:US
Mailing Address - Phone:740-266-4908
Mailing Address - Fax:740-264-4376
Practice Address - Street 1:3169 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-4711
Practice Address - Country:US
Practice Address - Phone:740-266-4908
Practice Address - Fax:740-264-4376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV885111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T30114Medicare PIN