Provider Demographics
NPI:1891965547
Name:DIDIO CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:DIDIO CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIDIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-283-0500
Mailing Address - Street 1:4971 HOUSTON RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1365
Mailing Address - Country:US
Mailing Address - Phone:859-283-0500
Mailing Address - Fax:859-283-0502
Practice Address - Street 1:4971 HOUSTON RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1365
Practice Address - Country:US
Practice Address - Phone:859-283-0500
Practice Address - Fax:859-283-0502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4648111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2413114Medicaid
OH2413114Medicaid