Provider Demographics
NPI:1023479862
Name:GIZAW CHIROPRACTIC
Entity type:Organization
Organization Name:GIZAW CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WEGAYEHU
Authorized Official - Middle Name:
Authorized Official - Last Name:GIZAW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-497-9478
Mailing Address - Street 1:67 BETHEL ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-5807
Mailing Address - Country:US
Mailing Address - Phone:570-861-6651
Mailing Address - Fax:
Practice Address - Street 1:222 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1441
Practice Address - Country:US
Practice Address - Phone:570-497-9478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011124111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty