MEDICARE: DR. C. HERBERT WILLSON III DC

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	DC001999L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831124627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. C. HERBERT WILLSON III DC

Provider Business Mailing Address
First Line	:	209 RICHLAND AVE
Second Line	:
City	:	DRAVOSBURG
State	:	PA
Zip	:	15034
Country	:	US
Telephone Number	:	412-469-2000
Fax Number	:	412-466-2199

Provider Business Practice Location Address
First Line	:	209 RICHLAND AVE
Second Line	:
City	:	DRAVOSBURG
State	:	PA
Zip	:	15034-1160
Country	:	US
Telephone Number	:	412-469-2000
Fax Number	:	412-466-2199

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	08/04/2010

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