Provider Demographics
NPI:1528061579
Name:WENSINK, NEIL R (DC)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:R
Last Name:WENSINK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28821 LORAIN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-4013
Mailing Address - Country:US
Mailing Address - Phone:440-716-8400
Mailing Address - Fax:440-716-8401
Practice Address - Street 1:28821 LORAIN RD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-4013
Practice Address - Country:US
Practice Address - Phone:440-716-8400
Practice Address - Fax:440-716-8401
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3226111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000282908OtherANTHEM BC/BS
OHWE9332911Medicare ID - Type UnspecifiedMEDICARE GROUP
OHWE4102551Medicare PIN
OH000000282908OtherANTHEM BC/BS