Provider Demographics
NPI:1992824973
Name:SIDNEY CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:SIDNEY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHUBERT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:937-492-4681
Mailing Address - Street 1:1640 GLEASON ST
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-3561
Mailing Address - Country:US
Mailing Address - Phone:937-492-4681
Mailing Address - Fax:937-492-7200
Practice Address - Street 1:1640 GLEASON ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-3561
Practice Address - Country:US
Practice Address - Phone:937-492-4681
Practice Address - Fax:937-492-7200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3364111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000480195OtherANTHEM PIN
OH2432228Medicaid
OHSI9356751OtherMEDICARE GROUP
OHSC4115272Medicare ID - Type UnspecifiedMEDICARE PROVIDER
OH2432228Medicaid