Provider Demographics
NPI:1568591519
Name:WOLANSKY, ROMAN (DC)
Entity Type:Individual
Prefix:
First Name:ROMAN
Middle Name:
Last Name:WOLANSKY
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:PO BOX 591
Mailing Address - Street 2:
Mailing Address - City:LINCOLN CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97367-0591
Mailing Address - Country:US
Mailing Address - Phone:541-994-3430
Mailing Address - Fax:
Practice Address - Street 1:1443 NW 15TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-0591
Practice Address - Country:US
Practice Address - Phone:541-994-3430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1211111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORZ14445Medicaid
OR0000QGBDVMedicare ID - Type Unspecified