Provider Demographics
NPI:1558546457
Name:CHEVALIER CHIROPRACTIC INC.
Entity type:Organization
Organization Name:CHEVALIER CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHEVALIER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:330-834-1444
Mailing Address - Street 1:7257 FULTON DR NW
Mailing Address - Street 2:SUITE 73
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3816
Mailing Address - Country:US
Mailing Address - Phone:330-834-1444
Mailing Address - Fax:330-834-0444
Practice Address - Street 1:7257 FULTON DR NW
Practice Address - Street 2:SUITE 73
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3816
Practice Address - Country:US
Practice Address - Phone:330-834-1444
Practice Address - Fax:330-834-0444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2232111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2091187Medicaid
OH2091187Medicaid
OH4030241Medicare PIN