Healthcare Provider Details

I. General information

NPI: 1518563923
Provider Name (Legal Business Name): JOSEPH WILLIAM TAIT II DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2020
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 E STATE ST
ALLIANCE OH
44601-4913
US

IV. Provider business mailing address

641 E STATE ST
ALLIANCE OH
44601-4913
US

V. Phone/Fax

Practice location:
  • Phone: 330-821-4455
  • Fax: 330-821-4504
Mailing address:
  • Phone: 330-821-4455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-05013
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: