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General NPI Number Information
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NPI Number | 1942740030
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Entity Type | Organization
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Legal Business Name | STRUCTURED CHIROPRACTIC
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Dates
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Enumeration Date | 03/08/2017
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Last Update Date | 03/08/2017
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Provider Practice Location Address
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Address Line | 416 ALLEGHENY RIVER BLVD SUITE 203
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City | OAKMONT
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State | PA
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Zip | 15139-1735
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Country | US
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Telephone | 412-828-6000
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Fax | 412-828-6006
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Provider Business Mailing Address
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Address Line | 416 ALLEGHENY RIVER BLVD SUITE 203
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City | OAKMONT
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State | PA
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Zip | 15139-1735
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Country | US
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Telephone | 412-828-6000
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Fax | 412-828-6006
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. JACQUE HOYT MOSER III
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Credential | D.C
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Telephone | 412-828-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | AJ010944
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC011184
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License Number State | PA
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