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General NPI Number Information
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NPI Number | 1114004298
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Entity Type | Organization
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Legal Business Name | WANSOR-MOSES CHIROPRACTIC OFFICE
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 10/23/2007
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Provider Practice Location Address
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Address Line | 6578 N.Y.S. ROUTE 12
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City | NORWICH
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State | NY
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Zip | 13815
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Country | US
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Telephone | 607-334-4703
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Fax | 607-334-4703
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Provider Business Mailing Address
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Address Line | 6578 N.Y.S. ROUTE 12
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City | NORWICH
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State | NY
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Zip | 13815
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Country | US
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Telephone | 607-334-4703
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Fax | 607-334-4703
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT EDWARD WANSOR
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Credential | D.C.
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Telephone | 607-334-4703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | X004496
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License Number State | NY
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