=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609083906
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROMESBURG'S NORTH CENTRAL CHIROPRACTIC CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2007
-----------------------------------------------------
Last Update Date | 07/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 351 E MAIN ST
-----------------------------------------------------
City | BRIDGEPORT
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26330-1845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-842-6993
-----------------------------------------------------
Fax | 304-842-4661
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 351 E MAIN ST
-----------------------------------------------------
City | BRIDGEPORT
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26330-1845
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-842-6993
-----------------------------------------------------
Fax | 304-842-4661
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SCOTT K ROMESBURG JR.
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 304-842-6993
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Chiropractor
-----------------------------------------------------
License Number | 322
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------