Provider Demographics
NPI:1700801198
Name:PRESTON, WENDI ANN (DC)
Entity type:Individual
Prefix:DR
First Name:WENDI
Middle Name:ANN
Last Name:PRESTON
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 1:4190 HOLIDAY ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2532
Mailing Address - Country:US
Mailing Address - Phone:330-966-0030
Mailing Address - Fax:
Practice Address - Street 1:4190 HOLIDAY ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2532
Practice Address - Country:US
Practice Address - Phone:330-966-0030
Practice Address - Fax:330-966-4837
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3046111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2219898Medicaid
OHPR4042501Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
OHPR9314261Medicare ID - Type UnspecifiedMEDICARE GROUP