=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538337472
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TROY W. ZACHERL D.C., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2008
-----------------------------------------------------
Last Update Date | 02/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4720 WATTSBURG ROAD
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16504-2742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-825-1102
-----------------------------------------------------
Fax | 814-825-3292
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4720 WATTSBURG ROAD
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16504-2742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-825-1102
-----------------------------------------------------
Fax | 814-825-3292
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. TROY W. ZACHERL
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 814-825-1102
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NS0005X
-----------------------------------------------------
Taxonomy Name | Sports Physician Chiropractor
-----------------------------------------------------
License Number | DC007449L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC007449L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------