Provider Demographics
NPI:1366716672
Name:CHIROPRACTIC AND WELLNESS WORKS,LLC
Entity type:Organization
Organization Name:CHIROPRACTIC AND WELLNESS WORKS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MENNOW
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:724-342-7778
Mailing Address - Street 1:490 N KERRWOOD DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-5202
Mailing Address - Country:US
Mailing Address - Phone:724-342-7778
Mailing Address - Fax:724-342-7373
Practice Address - Street 1:490 N KERRWOOD DR
Practice Address - Street 2:SUITE 204
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-5202
Practice Address - Country:US
Practice Address - Phone:724-342-7778
Practice Address - Fax:724-342-7373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010518111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA002678882OtherHIGHMARK OF PENNSYLVANIA