=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437413341
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEBSTER CHIROPRACTIC & SPORTS REHABILITATION, PLLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2012
-----------------------------------------------------
Last Update Date | 06/26/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 767 DRY RUN RD
-----------------------------------------------------
City | MONONGAHELA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15063-1226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-258-6506
-----------------------------------------------------
Fax | 724-292-7211
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 767 DRY RUN RD
-----------------------------------------------------
City | MONONGAHELA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15063-1226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-258-6506
-----------------------------------------------------
Fax | 724-292-7211
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | COLIN MICHAEL WEBSTER
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 724-258-6506
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC010251
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------