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General NPI Number Information
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NPI Number | 1649490541
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Entity Type | Organization
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Legal Business Name | WOOSTER CHIROPRACTIC CLINIC INC.
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 521 BEALL AVE
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City | WOOSTER
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State | OH
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Zip | 44691-3589
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Country | US
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Telephone | 330-263-5365
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Fax | 330-262-6975
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Provider Business Mailing Address
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Address Line | 521 BEALL AVE P.O. BOX 1052
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City | WOOSTER
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State | OH
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Zip | 44691-3589
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Country | US
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Telephone | 330-263-5365
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Fax | 330-262-6975
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | EDWARD W. COLVIN
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Credential | DC
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Telephone | 330-263-5365
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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 | OH1443
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License Number State | OH
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