Provider Demographics
NPI:1396739322
Name:WANAMAKER, KAREN RITA (DC)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:RITA
Last Name:WANAMAKER
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 1:107 DAYTONA AVE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-2203
Mailing Address - Country:US
Mailing Address - Phone:585-670-9405
Mailing Address - Fax:
Practice Address - Street 1:2082 FIVE MILE LINE RD
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-1450
Practice Address - Country:US
Practice Address - Phone:585-249-0760
Practice Address - Fax:585-249-0761
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6526111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
101871ANOtherPREFERED CARE
P01006526OtherEXCELLUS BSBC
10443BMedicare ID - Type Unspecified
101871ANOtherPREFERED CARE