1225236987 NPI number — CHARLTON CHIROPRACTIC & WELLNESS CENTER LLC

Table of content: (NPI 1225236987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225236987 NPI number — CHARLTON CHIROPRACTIC & WELLNESS CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLTON CHIROPRACTIC & WELLNESS CENTER LLC
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:
1225236987
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22752 HARRISBURG WESTVILLE RD
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
ALLIANCE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44601-9224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-829-1962
Provider Business Mailing Address Fax Number:
330-829-9875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22752 HARRISBURG WESTVILLE RD
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
ALLIANCE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44601-9224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-829-1962
Provider Business Practice Location Address Fax Number:
330-829-9875
Provider Enumeration Date:
07/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCHILLIG
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
D
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
330-829-1962

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2754 , 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: 28968565002 . This is a "MEDICAL MUTUAL ID NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000204822 . This is a "ANTHEM ID NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 28968565000 . This is a "BWC NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2092506 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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