Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | AJ-004293-L | PA |
NPI | 1093929614 |
---|---|
Provider Name | Dr. Celeste Anne Wine |
First Address | West Chester, PA 19382-5416 |
Second Address | West Chester, PA 19382-5416 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 08/07/2007 |