Provider Demographics
NPI:1649490541
Name:WOOSTER CHIROPRACTIC CLINIC INC.
Entity type:Organization
Organization Name:WOOSTER CHIROPRACTIC CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:COLVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-263-5365
Mailing Address - Street 1:521 BEALL AVE
Mailing Address - Street 2:P.O. BOX 1052
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-3589
Mailing Address - Country:US
Mailing Address - Phone:330-263-5365
Mailing Address - Fax:330-262-6975
Practice Address - Street 1:521 BEALL AVE
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-3589
Practice Address - Country:US
Practice Address - Phone:330-263-5365
Practice Address - Fax:330-262-6975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH1443111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0771839Medicaid
OH1982716148OtherEDWARD W COLVIN - NPI
OH0771839Medicaid