Provider Demographics
NPI:1134427693
Name:WYOMING CHIROPRACTIC CENTER INC
Entity type:Organization
Organization Name:WYOMING CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MUSA
Authorized Official - Middle Name:
Authorized Official - Last Name:AJAJ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-457-4422
Mailing Address - Street 1:441 E WYOMIMG AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-4541
Mailing Address - Country:US
Mailing Address - Phone:215-457-4422
Mailing Address - Fax:
Practice Address - Street 1:441 E WYOMING AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-4541
Practice Address - Country:US
Practice Address - Phone:215-457-4422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-08
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006475L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAAJ696397Medicare UPIN