Provider Demographics
NPI:1841204534
Name:MIDWAY HEALTHCARE SERVICES PA
Entity Type:Organization
Organization Name:MIDWAY HEALTHCARE SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERNYAVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-644-7207
Mailing Address - Street 1:1919 UNIVERSITY AVE W
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3453
Mailing Address - Country:US
Mailing Address - Phone:651-644-7207
Mailing Address - Fax:651-644-6653
Practice Address - Street 1:1919 UNIVERSITY AVE W
Practice Address - Street 2:SUITE 105
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3453
Practice Address - Country:US
Practice Address - Phone:651-644-7207
Practice Address - Fax:651-644-6653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4353111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN=========OtherEMPLOYER IDENTIFICATION