Provider Demographics
NPI:1669414298
Name:WASHINGTON CHIROPRACTIC CENTER, INC.
Entity type:Organization
Organization Name:WASHINGTON CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:CROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-225-1655
Mailing Address - Street 1:382 W CHESTNUT ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-4642
Mailing Address - Country:US
Mailing Address - Phone:724-225-1655
Mailing Address - Fax:724-225-6670
Practice Address - Street 1:382 W CHESTNUT ST
Practice Address - Street 2:SUITE 103
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4642
Practice Address - Country:US
Practice Address - Phone:724-225-1655
Practice Address - Fax:724-225-6670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001731L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty