Provider Demographics
NPI:1437413341
Name:WEBSTER CHIROPRACTIC & SPORTS REHABILITATION, PLLC.
Entity Type:Organization
Organization Name:WEBSTER CHIROPRACTIC & SPORTS REHABILITATION, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WEBSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-258-6506
Mailing Address - Street 1:767 DRY RUN RD
Mailing Address - Street 2:
Mailing Address - City:MONONGAHELA
Mailing Address - State:PA
Mailing Address - Zip Code:15063-1226
Mailing Address - Country:US
Mailing Address - Phone:724-258-6506
Mailing Address - Fax:724-292-7211
Practice Address - Street 1:767 DRY RUN RD
Practice Address - Street 2:
Practice Address - City:MONONGAHELA
Practice Address - State:PA
Practice Address - Zip Code:15063-1226
Practice Address - Country:US
Practice Address - Phone:724-258-6506
Practice Address - Fax:724-292-7211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010251111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
144563853OtherNPI