Provider Demographics
NPI:1801961610
Name:SPINAL HEALTH AND WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:SPINAL HEALTH AND WELLNESS CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:JEANETTE
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-742-1777
Mailing Address - Street 1:213 EXECUTIVE DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6442
Mailing Address - Country:US
Mailing Address - Phone:724-742-1777
Mailing Address - Fax:724-742-1780
Practice Address - Street 1:213 EXECUTIVE DR
Practice Address - Street 2:SUITE 120
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-6442
Practice Address - Country:US
Practice Address - Phone:724-742-1777
Practice Address - Fax:724-742-1780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009032111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5644102OtherFIRST HEALTH
PA1527835OtherHIGHMARK BLUE CROSS
PA3312788OtherAETNA
PA4070935OtherCIGNA
PA1049160OtherAMERICAN SPECIALY HEALTH
PA554942OtherHEALTH AMERICA/HEALTH ASSURANCE
PA400602OtherUPMC
PA400602OtherUPMC
PA1527835OtherHIGHMARK BLUE CROSS