Provider Demographics
NPI:1063780294
Name:CHAFFEE FAMILY CHIRO INC
Entity type:Organization
Organization Name:CHAFFEE FAMILY CHIRO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHAFFEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-345-4440
Mailing Address - Street 1:242 E MILLTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-1246
Mailing Address - Country:US
Mailing Address - Phone:330-345-4440
Mailing Address - Fax:330-345-9335
Practice Address - Street 1:5336 C.R. 201
Practice Address - Street 2:SUITE C
Practice Address - City:MILLERSBURG
Practice Address - State:OH
Practice Address - Zip Code:44654-9251
Practice Address - Country:US
Practice Address - Phone:330-893-0444
Practice Address - Fax:330-893-9335
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHAFFEE CHIROPRACTIC CLINIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-02
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1970111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH085630Medicare PIN