Provider Demographics
NPI:1922287366
Name:WINGERT-ADAMS, MICHELLE RENE (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:RENE
Last Name:WINGERT-ADAMS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 S LEHIGH AVE
Mailing Address - Street 2:PO BOX 525
Mailing Address - City:FRACKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17931-2205
Mailing Address - Country:US
Mailing Address - Phone:570-874-3002
Mailing Address - Fax:570-874-2829
Practice Address - Street 1:246 S LEHIGH AVE
Practice Address - Street 2:
Practice Address - City:FRACKVILLE
Practice Address - State:PA
Practice Address - Zip Code:17931-2205
Practice Address - Country:US
Practice Address - Phone:570-874-3002
Practice Address - Fax:570-874-2829
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-005547-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAWI767116Medicare PIN
PAU49418Medicare UPIN