1407942881 NPI number — BELL FAMILY CHIROPRACTIC CLINIC PROFESSIONAL CORPORATION

Table of content: (NPI 1407942881)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407942881 NPI number — BELL FAMILY CHIROPRACTIC CLINIC PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BELL FAMILY CHIROPRACTIC CLINIC PROFESSIONAL CORPORATION
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:
6
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:
1407942881
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2852 CADWALLADER SONK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORTLAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44410-9411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-637-1256
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3030 STATE ROUTE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORTLAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44410-9271
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-637-2225
Provider Business Practice Location Address Fax Number:
330-637-2226
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WALDRON
Authorized Official First Name:
TODD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
330-637-2225

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2680 , 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: 2081518 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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