Provider Demographics
NPI:1720129786
Name:CHRISTIAN, LORI (DC)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 RICHMOND RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4477
Mailing Address - Country:US
Mailing Address - Phone:216-595-9999
Mailing Address - Fax:216-595-0235
Practice Address - Street 1:3355 RICHMOND RD
Practice Address - Street 2:SUITE 120
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4100
Practice Address - Country:US
Practice Address - Phone:216-595-9999
Practice Address - Fax:216-595-0235
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1135111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0574544Medicare PIN