1639704752 NPI number — OHIO CHIROPRACTIC AND PHYSICAL MEDICINE

Table of content: (NPI 1639704752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639704752 NPI number — OHIO CHIROPRACTIC AND PHYSICAL MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OHIO CHIROPRACTIC AND PHYSICAL MEDICINE
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:
1639704752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3700 RIVERSIDE DR UNIT 21305
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43221-7013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-964-2341
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3380 TREMONT RD STE 190
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43221-2112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-964-2341
Provider Business Practice Location Address Fax Number:
614-957-0845
Provider Enumeration Date:
03/09/2020

Additional Information

Authorized Official

Authorized Official Last Name:
CAINE
Authorized Official First Name:
SEAN
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
614-512-8269

Provider Taxonomy Codes

  • Taxonomy code: 111NR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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