Provider Demographics
NPI:1578528964
Name:WANO, TONY (DC)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:
Last Name:WANO
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 1:193 W BEAU ST
Mailing Address - Street 2:JEFFERSON COURT PLAZA
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-4401
Mailing Address - Country:US
Mailing Address - Phone:724-222-8322
Mailing Address - Fax:724-222-8940
Practice Address - Street 1:193 W BEAU ST
Practice Address - Street 2:JEFFERSON COURT PLAZA
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4401
Practice Address - Country:US
Practice Address - Phone:724-222-8322
Practice Address - Fax:724-222-8940
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005027L111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016115200004Medicaid
PA076534Medicare ID - Type UnspecifiedMEDICARE GROUP ID#
PAU47229Medicare UPIN