Provider Demographics
NPI:1366457715
Name:RAISHART, WARREN J (D C)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:J
Last Name:RAISHART
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 MISSION RD.
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-2827
Mailing Address - Country:US
Mailing Address - Phone:724-539-9445
Mailing Address - Fax:724-539-9445
Practice Address - Street 1:1202 MISSION RD
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-2827
Practice Address - Country:US
Practice Address - Phone:724-539-9445
Practice Address - Fax:724-539-9445
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007674L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
040177Medicare ID - Type Unspecified
PAU81197Medicare UPIN