Provider Demographics
NPI:1851770242
Name:CELTIC HIGHLANDER LLC
Entity Type:Organization
Organization Name:CELTIC HIGHLANDER LLC
Other - Org Name:WEXFORD WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-719-3237
Mailing Address - Street 1:12985 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7319
Mailing Address - Country:US
Mailing Address - Phone:724-719-3237
Mailing Address - Fax:724-719-3236
Practice Address - Street 1:12985 PERRY HWY
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-7319
Practice Address - Country:US
Practice Address - Phone:724-719-3237
Practice Address - Fax:724-719-3236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003703L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty