1487642500 NPI number — CELINA CHIROPRACTIC CARE 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 1487642500 NPI number — CELINA CHIROPRACTIC CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CELINA CHIROPRACTIC CARE 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:
1487642500
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
909 N MAIN ST STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CELINA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45822-1010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-584-2225
Provider Business Mailing Address Fax Number:
419-584-1876

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
909 N MAIN ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CELINA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45822-1010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-584-2225
Provider Business Practice Location Address Fax Number:
419-584-1876
Provider Enumeration Date:
10/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LISHNESS
Authorized Official First Name:
LORENE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
419-657-6262

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1831285196 . This is a "DR PRUITT NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1124016373 . This is a "DR VAN ARSDEL NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2385200 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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