Provider Demographics
NPI:1578647343
Name:WIRICK, JUSTIN CARL (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:CARL
Last Name:WIRICK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39000 MENTOR AVE
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-8095
Mailing Address - Country:US
Mailing Address - Phone:440-953-3950
Mailing Address - Fax:440-953-3953
Practice Address - Street 1:39000 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-8095
Practice Address - Country:US
Practice Address - Phone:440-953-3950
Practice Address - Fax:440-953-3953
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3589111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor