Provider Demographics
NPI:1861575441
Name:WYOMING VALLEY FAMILY CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:WYOMING VALLEY FAMILY CHIROPRACTIC CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:MAHLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:570-283-1610
Mailing Address - Street 1:1144 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:FORTY FORT
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4015
Mailing Address - Country:US
Mailing Address - Phone:570-283-1610
Mailing Address - Fax:570-763-4134
Practice Address - Street 1:1144 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:FORTY FORT
Practice Address - State:PA
Practice Address - Zip Code:18704-4015
Practice Address - Country:US
Practice Address - Phone:570-283-1610
Practice Address - Fax:570-763-4134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008627111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001877416003Medicaid
PA817976OtherFIRST PRIORITY
PA1828303OtherBC/ BS
PAU87885Medicare UPIN
PA1828303OtherBC/ BS