Provider Demographics
NPI:1598838419
Name:W R MUNSTER DC PA
Entity Type:Organization
Organization Name:W R MUNSTER DC PA
Other - Org Name:WOLFGANG R. MUNSTER, D.C.,P.A
Other - Org Type:Other Name
Authorized Official - Title/Position:P,VP
Authorized Official - Prefix:DR
Authorized Official - First Name:WOLFGANG
Authorized Official - Middle Name:R
Authorized Official - Last Name:MUNSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-322-9800
Mailing Address - Street 1:687 BEVILLE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-1951
Mailing Address - Country:US
Mailing Address - Phone:386-322-9800
Mailing Address - Fax:386-322-9808
Practice Address - Street 1:687 BEVILLE RD
Practice Address - Street 2:SUITE B
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-1951
Practice Address - Country:US
Practice Address - Phone:386-322-9800
Practice Address - Fax:386-322-9808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH1672111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89367OtherBLUE CROSS BS ID#
FL89367OtherBLUE CROSS BS ID#
FL89367OtherBLUE CROSS BS ID#