Provider Demographics
NPI:1306154521
Name:BARBERTON CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:BARBERTON CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:NENADOV
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-745-2033
Mailing Address - Street 1:637 W TUSCARAWAS AVE
Mailing Address - Street 2:
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-2430
Mailing Address - Country:US
Mailing Address - Phone:330-745-2033
Mailing Address - Fax:330-745-0282
Practice Address - Street 1:637 W TUSCARAWAS AVE
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-2430
Practice Address - Country:US
Practice Address - Phone:330-745-2033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:URGENT CARE AND MEDICAL CHIROPRACTIC REHAB
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-22
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH626111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0466240Medicaid
OH341347537OtherTAX ID
OH341347537OtherTAX ID