Provider Demographics
NPI:1285812602
Name:THEIS CHIROPRACTIC CLINIC, INC.
Entity type:Organization
Organization Name:THEIS CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:THEIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-433-9000
Mailing Address - Street 1:6525 MARKET AVE N
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44721-2430
Mailing Address - Country:US
Mailing Address - Phone:330-433-9000
Mailing Address - Fax:330-433-9026
Practice Address - Street 1:6525 MARKET AVE N
Practice Address - Street 2:SUITE 101
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44721-2430
Practice Address - Country:US
Practice Address - Phone:330-433-9000
Practice Address - Fax:330-433-9026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1826261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0854197Medicaid
OH0854197Medicaid
OHU27898Medicare UPIN