Provider Demographics
NPI:1194905463
Name:CUYAHOGA FALLS CHIROPRACTIC CLINIC, INC
Entity type:Organization
Organization Name:CUYAHOGA FALLS CHIROPRACTIC CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:330-920-1681
Mailing Address - Street 1:748 GRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-1042
Mailing Address - Country:US
Mailing Address - Phone:330-920-1681
Mailing Address - Fax:330-920-1669
Practice Address - Street 1:748 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-1042
Practice Address - Country:US
Practice Address - Phone:330-920-1681
Practice Address - Fax:330-920-1669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1138111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCU9332631OtherGROUP MEDICARE
OH0573314Medicare PIN
OHCU9332631OtherGROUP MEDICARE