Provider Demographics
NPI:1952461683
Name:WESTSIDE WELLNESS CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:WESTSIDE WELLNESS CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:SERINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:610-687-8988
Mailing Address - Street 1:230 SUGARTOWN RD
Mailing Address - Street 2:SUITE 60
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-6003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:230 SUGARTOWN RD
Practice Address - Street 2:SUITE 60
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3029
Practice Address - Country:US
Practice Address - Phone:610-687-8988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009341111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2400364000OtherINDEPENDENCE BLUE CROSS
PA1695784OtherHIGHMARK
PA7531628OtherAETNA PPO
PA7531628OtherAETNA PPO