Provider Demographics
NPI:1861491482
Name:WISNIEWSKI, NICHOLAS E (DC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:E
Last Name:WISNIEWSKI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AMBASSADOR BLDG.
Mailing Address - Street 2:1409 DUNCAN AVE.
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237
Mailing Address - Country:US
Mailing Address - Phone:412-366-6061
Mailing Address - Fax:412-366-4664
Practice Address - Street 1:AMBASSADOR BLDG.
Practice Address - Street 2:1409 DUNCAN AVE.
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237
Practice Address - Country:US
Practice Address - Phone:412-366-6061
Practice Address - Fax:412-366-4664
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 001750L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
035309Medicare UPIN
035309Medicare ID - Type Unspecified