Provider Demographics
NPI:1669648846
Name:WANAMAKER CHIROPRACTIC
Entity Type:Organization
Organization Name:WANAMAKER CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WANAMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-694-9864
Mailing Address - Street 1:12765 S SAGINAW ST STE 403
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2450
Mailing Address - Country:US
Mailing Address - Phone:810-695-9864
Mailing Address - Fax:810-695-1071
Practice Address - Street 1:12765 S SAGINAW ST STE 403
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2450
Practice Address - Country:US
Practice Address - Phone:810-695-9864
Practice Address - Fax:810-695-1071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty