Provider Demographics
NPI:1457423675
Name:WESTERN PENNSYLVANIA SPINE INSTITUTE, P.C.
Entity Type:Organization
Organization Name:WESTERN PENNSYLVANIA SPINE INSTITUTE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-731-0007
Mailing Address - Street 1:1900 WATERDAM PLAZA
Mailing Address - Street 2:BLDG #3
Mailing Address - City:MCMURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-5442
Mailing Address - Country:US
Mailing Address - Phone:724-731-0007
Mailing Address - Fax:724-731-0040
Practice Address - Street 1:1900 WATERDAM PLAZA
Practice Address - Street 2:BLDG #3
Practice Address - City:MCMURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-5442
Practice Address - Country:US
Practice Address - Phone:724-731-0007
Practice Address - Fax:724-731-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005679L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA619690R7BOtherPROVIDER MEDICARE PIN
PA1376676007OtherPROVIDER NPI
PA1457423675OtherMEDICARE NPI
PA1457423675OtherMEDICARE NPI
PACH074389Medicare PIN