Provider Demographics
NPI:1134434202
Name:CHIC WIGS LLC
Entity type:Organization
Organization Name:CHIC WIGS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTIUZZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:905-206-5503
Mailing Address - Street 1:2180 MATHESON BLVD EAST. UNIT 1
Mailing Address - Street 2:
Mailing Address - City:MISSISSAUGA
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L4W5E1
Mailing Address - Country:CA
Mailing Address - Phone:1866-363-7768
Mailing Address - Fax:1800-265-7775
Practice Address - Street 1:5630 PEACH STR
Practice Address - Street 2:B-19
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16565
Practice Address - Country:US
Practice Address - Phone:814-864-7454
Practice Address - Fax:814-864-7454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-13
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies