MEDICARE: WILLIAMSBURG CHIROPRACTIC OFFICE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3010	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568534345
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAMSBURG CHIROPRACTIC OFFICE, INC

Provider Business Mailing Address
First Line	:	331 S 5TH ST
Second Line	:
City	:	WILLIAMSBURG
State	:	OH
Zip	:	45176-1004
Country	:	US
Telephone Number	:	513-724-1600
Fax Number	:	513-724-1601

Provider Business Practice Location Address
First Line	:	331 S 5TH ST
Second Line	:
City	:	WILLIAMSBURG
State	:	OH
Zip	:	45176-1004
Country	:	US
Telephone Number	:	513-724-1600
Fax Number	:	513-724-1601

Authorized Official
Title or Position	:	CHIROPRACTIC
Name	:	TRAVIS DAIL FISHER
Credential	:	DC
Telephone Number	:	513-724-1600

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	02/19/2024

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