Provider Demographics
NPI:1942740030
Name:STRUCTURED CHIROPRACTIC
Entity Type:Organization
Organization Name:STRUCTURED CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUE
Authorized Official - Middle Name:HOYT
Authorized Official - Last Name:MOSER
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:412-828-6000
Mailing Address - Street 1:416 ALLEGHENY RIVER BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:OAKMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15139-1735
Mailing Address - Country:US
Mailing Address - Phone:412-828-6000
Mailing Address - Fax:412-828-6006
Practice Address - Street 1:416 ALLEGHENY RIVER BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:OAKMONT
Practice Address - State:PA
Practice Address - Zip Code:15139-1735
Practice Address - Country:US
Practice Address - Phone:412-828-6000
Practice Address - Fax:412-828-6006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC011184111N00000X
PAAJ010944111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty