Provider Demographics
NPI:1881768315
Name:ZHAO, WENNING (DC R ACUPUNCTURIST)
Entity type:Individual
Prefix:MR
First Name:WENNING
Middle Name:
Last Name:ZHAO
Suffix:
Gender:M
Credentials:DC R ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15751 BROADWAY AVE
Mailing Address - Street 2:MAPLE TOWN SHOPPING CENTER
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137
Mailing Address - Country:US
Mailing Address - Phone:216-581-0321
Mailing Address - Fax:216-332-0386
Practice Address - Street 1:15751 BROADWAY AVE
Practice Address - Street 2:MAPLE TOWN SHOPPING CENTER
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137
Practice Address - Country:US
Practice Address - Phone:216-581-0321
Practice Address - Fax:216-332-0386
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2082111N00000X
OH65000035171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH61715OtherQUAL CHOICE
000000319116OtherANTHEM BLUE CROSS
OH0975619Medicaid
OHAB9327111Medicare ID - Type UnspecifiedMEDICARE GROUP
OH0975619Medicaid
ZH0765273Medicare ID - Type Unspecified