Provider Demographics
NPI:1023282324
Name:ALTERNATIVE HEALTHCARE OF ST MARYS, PA.
Entity type:Organization
Organization Name:ALTERNATIVE HEALTHCARE OF ST MARYS, PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WERTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:785-321-1700
Mailing Address - Street 1:513 W BERTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:KS
Mailing Address - Zip Code:66536-1658
Mailing Address - Country:US
Mailing Address - Phone:785-321-1700
Mailing Address - Fax:785-321-1702
Practice Address - Street 1:513 W BERTRAND AVE
Practice Address - Street 2:
Practice Address - City:ST. MARYS
Practice Address - State:KS
Practice Address - Zip Code:66536-0236
Practice Address - Country:US
Practice Address - Phone:785-321-1700
Practice Address - Fax:785-321-1702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST05197111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA1125001OtherMEDICARE PTAN