Provider Demographics
NPI:1760559736
Name:WEST READING CHIROPRACTIC CENTER, P.C.
Entity Type:Organization
Organization Name:WEST READING CHIROPRACTIC CENTER, P.C.
Other - Org Name:WOLF CHIROPRACTIC CENTER OF WYOMISSING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-374-3861
Mailing Address - Street 1:1813 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LAWN
Mailing Address - State:PA
Mailing Address - Zip Code:19609-2078
Mailing Address - Country:US
Mailing Address - Phone:610-374-3861
Mailing Address - Fax:610-372-8019
Practice Address - Street 1:1813 PENN AVE
Practice Address - Street 2:
Practice Address - City:WEST LAWN
Practice Address - State:PA
Practice Address - Zip Code:19609-2078
Practice Address - Country:US
Practice Address - Phone:610-374-3861
Practice Address - Fax:610-372-8019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004040L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA564393Medicare ID - Type Unspecified
PAU58743Medicare UPIN