Provider Demographics
NPI:1396280111
Name:BLUE RIBBON CHIROPRACTIC LLC
Entity type:Organization
Organization Name:BLUE RIBBON CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:N
Authorized Official - Last Name:BRADEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-482-2556
Mailing Address - Street 1:101 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIANA
Mailing Address - State:OH
Mailing Address - Zip Code:44408-1352
Mailing Address - Country:US
Mailing Address - Phone:330-482-2556
Mailing Address - Fax:330-482-3114
Practice Address - Street 1:101 E PARK AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:OH
Practice Address - Zip Code:44408-1352
Practice Address - Country:US
Practice Address - Phone:330-482-2556
Practice Address - Fax:330-482-3114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4582111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty