Provider Demographics
NPI:1316123623
Name:LODI FAMILY CHIROPRACTIC CORP
Entity type:Organization
Organization Name:LODI FAMILY CHIROPRACTIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LONGO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-948-7246
Mailing Address - Street 1:600 WOOSTER ST
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:OH
Mailing Address - Zip Code:44254-1326
Mailing Address - Country:US
Mailing Address - Phone:330-948-7246
Mailing Address - Fax:330-948-7247
Practice Address - Street 1:600 WOOSTER ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:OH
Practice Address - Zip Code:44254-1326
Practice Address - Country:US
Practice Address - Phone:330-948-7246
Practice Address - Fax:330-948-7247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2495111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHVO4120Medicare UPIN
OHLO9351421Medicare PIN