Provider Demographics
NPI:1215105283
Name:MAINEVILLE FAMILY CHIROPRACTIC CENTER, INC.
Entity type:Organization
Organization Name:MAINEVILLE FAMILY CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:TITUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-677-7463
Mailing Address - Street 1:42 GRANDIN RD
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-9677
Mailing Address - Country:US
Mailing Address - Phone:513-677-7463
Mailing Address - Fax:513-677-8171
Practice Address - Street 1:42 GRANDIN RD
Practice Address - Street 2:
Practice Address - City:MAINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45039-9677
Practice Address - Country:US
Practice Address - Phone:513-677-7463
Practice Address - Fax:513-677-8171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2919111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2214133Medicaid
OHU87218Medicare UPIN
OH2214133Medicaid