Provider Demographics
NPI:1700218013
Name:WYOMING VALLEY SPINE AND NERVE INSTITUTE, INC
Entity Type:Organization
Organization Name:WYOMING VALLEY SPINE AND NERVE INSTITUTE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:GEHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-569-2250
Mailing Address - Street 1:400 ROUTE 315 HWY
Mailing Address - Street 2:STE A
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640-3912
Mailing Address - Country:US
Mailing Address - Phone:570-569-2250
Mailing Address - Fax:
Practice Address - Street 1:400 ROUTE 315 HWY
Practice Address - Street 2:STE A
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640-3912
Practice Address - Country:US
Practice Address - Phone:570-569-2250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009720111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty