MEDICARE: WADSWORTH CHIROPRACTIC LTD

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
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1689810160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WADSWORTH CHIROPRACTIC LTD

Provider Business Mailing Address
First Line	:	1392 HIGH ST
Second Line	:	109
City	:	WADSWORTH
State	:	OH
Zip	:	44281-8257
Country	:	US
Telephone Number	:	330-331-5320
Fax Number	:

Provider Business Practice Location Address
First Line	:	1392 HIGH ST
Second Line	:	109
City	:	WADSWORTH
State	:	OH
Zip	:	44281-8257
Country	:	US
Telephone Number	:	330-331-5320
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH JOHN HERBERT
Credential	:	D.C.
Telephone Number	:	330-331-5320

Provider Enumeration Date	:	01/05/2009
Last Update Date	:	01/05/2009

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