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NPI Code Detail

MEDICARE: DR. JUSTIN CARL WIRICK D.C.

MEDICARE: DR. JUSTIN CARL WIRICK D.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor3589OH

General Provider Information

NPI Number : 1578647343
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUSTIN CARL WIRICK D.C.
Provider Business Mailing Address
First Line : 39000 MENTOR AVE
Second Line :
City : WILLOUGHBY
State : OH
Zip : 44094-8095
Country : US
Telephone Number : 440-953-3950
Fax Number : 440-953-3953
Provider Business Practice Location Address
First Line : 39000 MENTOR AVE
Second Line :
City : WILLOUGHBY
State : OH
Zip : 44094-8095
Country : US
Telephone Number : 440-953-3950
Fax Number : 440-953-3953
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2006
Last Update Date : 11/19/2019

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