Provider Demographics
NPI:1699815472
Name:BEREA FAMILY CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:BEREA FAMILY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:CIRYAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-891-2225
Mailing Address - Street 1:44 WEST BAGLEY
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-1933
Mailing Address - Country:US
Mailing Address - Phone:440-891-2225
Mailing Address - Fax:440-891-0909
Practice Address - Street 1:44 WEST BAGLEY
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-1933
Practice Address - Country:US
Practice Address - Phone:440-891-2225
Practice Address - Fax:440-891-0909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3191111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9366101Medicare PIN