Provider Demographics
NPI:1467992131
Name:VANINA CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:VANINA CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:D
Authorized Official - Last Name:VANINA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-659-1454
Mailing Address - Street 1:25 E CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-1305
Mailing Address - Country:US
Mailing Address - Phone:610-659-1454
Mailing Address - Fax:
Practice Address - Street 1:368 N LEWIS RD
Practice Address - Street 2:
Practice Address - City:ROYERSFORD
Practice Address - State:PA
Practice Address - Zip Code:19468-1576
Practice Address - Country:US
Practice Address - Phone:610-948-1487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010785111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN120187500Medicaid
PA361459UHYMedicare PIN
MN120187500Medicaid