Provider Demographics
NPI:1902858335
Name:WANO CHIROPRACTIC WEIGHT LOSS & NUTRITION CENTERS, INC.
Entity Type:Organization
Organization Name:WANO CHIROPRACTIC WEIGHT LOSS & NUTRITION CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:E
Authorized Official - Last Name:WANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-222-8322
Mailing Address - Street 1:193 W BEAU ST
Mailing Address - Street 2:JEFFERSON COURT PLAZA
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-4401
Mailing Address - Country:US
Mailing Address - Phone:724-222-8322
Mailing Address - Fax:
Practice Address - Street 1:193 W BEAU ST
Practice Address - Street 2:JEFFERSON COURT PLAZA
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4401
Practice Address - Country:US
Practice Address - Phone:724-222-8322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005027L111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA16115200004Medicaid
PA076534Medicare ID - Type UnspecifiedMEDICARE GROUP #
PA16115200004Medicaid