Healthcare Provider Details

I. General information

NPI: 1942740030
Provider Name (Legal Business Name): STRUCTURED CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2017
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 ALLEGHENY RIVER BLVD SUITE 203
OAKMONT PA
15139-1735
US

IV. Provider business mailing address

416 ALLEGHENY RIVER BLVD SUITE 203
OAKMONT PA
15139-1735
US

V. Phone/Fax

Practice location:
  • Phone: 412-828-6000
  • Fax: 412-828-6006
Mailing address:
  • Phone: 412-828-6000
  • Fax: 412-828-6006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC011184
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberAJ010944
License Number StatePA

VIII. Authorized Official

Name: DR. JACQUE HOYT MOSER III
Title or Position: CHIROPRACTOR
Credential: D.C
Phone: 412-828-6000