Provider Demographics
NPI:1154587483
Name:WARDS CORNER CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:WARDS CORNER CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:PORTMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-677-6787
Mailing Address - Street 1:550 WARDS CORNER RD.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-6149
Mailing Address - Country:US
Mailing Address - Phone:513-677-6787
Mailing Address - Fax:513-677-2260
Practice Address - Street 1:550 WARDS CORNER RD.
Practice Address - Street 2:SUITE 101
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-6149
Practice Address - Country:US
Practice Address - Phone:513-677-6787
Practice Address - Fax:513-677-2260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0136043Medicaid
OH0136043Medicaid