Provider Demographics
NPI:1518048610
Name:WASNEY, DAN ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:ALLEN
Last Name:WASNEY
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 1:911 LOGAN BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602
Mailing Address - Country:US
Mailing Address - Phone:814-946-4000
Mailing Address - Fax:814-946-4777
Practice Address - Street 1:911 LOGAN BLVD
Practice Address - Street 2:LIFETIME CHIROPRACTIC LLC
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602
Practice Address - Country:US
Practice Address - Phone:814-946-4000
Practice Address - Fax:814-946-4777
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA008894111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001393376OtherBLUE CROSS PROVIDER #
PA067933RJ9Medicare ID - Type UnspecifiedMEDICARE PROVIDER #