=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831367911
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOORE CHIROPRACTIC & WELLNESS OF WOOSTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2008
-----------------------------------------------------
Last Update Date | 06/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 543 RIFFEL RD STE D WOOSTER, OHIO 44691
-----------------------------------------------------
City | WOOSTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44691-7216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-262-6655
-----------------------------------------------------
Fax | 330-345-1615
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 543 RIFFEL RD STE D WOOSTER, OHIO 44691
-----------------------------------------------------
City | WOOSTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44691-7216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-262-6655
-----------------------------------------------------
Fax | 330-345-1615
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF CHIROPRACTIC
-----------------------------------------------------
Name | DR. MARTY JACOB MOORE
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 330-262-6655
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3548
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------