Healthcare Provider Details

I. General information

NPI: 1356121305
Provider Name (Legal Business Name): MARION WALDO CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 E CENTER ST
MARION OH
43302-4244
US

IV. Provider business mailing address

491 E CENTER ST
MARION OH
43302-4244
US

V. Phone/Fax

Practice location:
  • Phone: 740-386-6580
  • Fax:
Mailing address:
  • Phone: 740-386-6580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DAVID ANDREW THARP
Title or Position: OWNER
Credential: DC
Phone: 817-807-1288