Provider Demographics
NPI:1366506784
Name:DAVID M BOOTH D.C. INC
Entity Type:Organization
Organization Name:DAVID M BOOTH D.C. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-498-7844
Mailing Address - Street 1:P.O.BOX 255
Mailing Address - Street 2:1200 E STATE STREET
Mailing Address - City:NEWCOMERSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43832-9448
Mailing Address - Country:US
Mailing Address - Phone:740-498-7844
Mailing Address - Fax:740-498-7504
Practice Address - Street 1:1200 E STATE RD
Practice Address - Street 2:
Practice Address - City:NEWCOMERSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43832-9448
Practice Address - Country:US
Practice Address - Phone:740-498-7844
Practice Address - Fax:740-498-7504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH934111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0517212Medicare PIN