Provider Demographics
NPI:1275602542
Name:MARION WALDO CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MARION WALDO CHIROPRACTIC LLC
Other - Org Name:THE OHIO NECK AND BACK PAIN RELIEF CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:THARP II
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-386-6580
Mailing Address - Street 1:491 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-4244
Mailing Address - Country:US
Mailing Address - Phone:740-386-6580
Mailing Address - Fax:740-386-6586
Practice Address - Street 1:491 E CENTER ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-4244
Practice Address - Country:US
Practice Address - Phone:740-386-6580
Practice Address - Fax:740-386-6586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3431111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2484084Medicaid
OH000000334224OtherANTHEM
OH27588332600OtherWORKERS COMPENSATION
OH000000334225OtherANTHEM
OH2493832Medicaid
OH275884806001OtherMEDICAL MUTUAL
OH27588480600OtherWORKERS COMPENSATION
OH275883326001OtherMEDICAL MUTUAL
OHP00161880Medicare ID - Type UnspecifiedRAILROAD MEDICARE
OH275884806001OtherMEDICAL MUTUAL
OH2493832Medicaid
OH000000334224OtherANTHEM
OHMA9374101Medicare ID - Type UnspecifiedMEDICARE