Provider Demographics
NPI:1386813335
Name:ACUTE LOW BACK CLINIC, INC.
Entity type:Organization
Organization Name:ACUTE LOW BACK CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:CYPHERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-756-0311
Mailing Address - Street 1:1144 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-2254
Mailing Address - Country:US
Mailing Address - Phone:419-756-0311
Mailing Address - Fax:419-756-0586
Practice Address - Street 1:1144 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-2254
Practice Address - Country:US
Practice Address - Phone:419-756-0311
Practice Address - Fax:419-756-0586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH43111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9318161Medicare PIN