1194823658 NPI number — ELYRIA CHIROPRACTIC SERVICES INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194823658 NPI number — ELYRIA CHIROPRACTIC SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELYRIA CHIROPRACTIC SERVICES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194823658
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
136 WINCKLES STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELYRIA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44035-6152
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-365-8323
Provider Business Mailing Address Fax Number:
440-365-8324

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
136 WINCKLES STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELYRIA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44035-6152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-365-8323
Provider Business Practice Location Address Fax Number:
440-365-8324
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEDOCS
Authorized Official First Name:
GENE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
440-365-8323

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  265 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30144353400 . This is a "MEDICAL MUTUAL OF OHIO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0651103 . This is a "AETNA LIFE INSURANCE COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4400203 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000127998 . This is a "ANTHEM BLUE CROSS BLUE SH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30144353400 . This is a "OHIO BUREAU OF WORKERS CO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0004382094 . This is a "AETNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com