Provider Demographics
NPI:1932318573
Name:DAWN INJURY & WELLNESS CENTER PLLC
Entity Type:Organization
Organization Name:DAWN INJURY & WELLNESS CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CALLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RADER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-428-9355
Mailing Address - Street 1:923 EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-2526
Mailing Address - Country:US
Mailing Address - Phone:304-428-9355
Mailing Address - Fax:304-428-2565
Practice Address - Street 1:923 EMERSON AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-2526
Practice Address - Country:US
Practice Address - Phone:304-428-9355
Practice Address - Fax:304-428-2565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV720111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1063297OtherWORKER'S COMPENSATION
WV001712610OtherBCBS
WV2202096-000Medicaid
WV2202096000Medicaid
WV7776862OtherCIGNA
WV2202096-000Medicaid
WV7776862OtherCIGNA
U78243Medicare UPIN