Provider Demographics
NPI:1003952482
Name:MID OHIO CHIROPRACTIC INC
Entity Type:Organization
Organization Name:MID OHIO CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOK
Authorized Official - Suffix:
Authorized Official - Credentials:DC FACO
Authorized Official - Phone:419-294-9490
Mailing Address - Street 1:714 N SANDUSKY AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:43351
Mailing Address - Country:US
Mailing Address - Phone:419-294-9490
Mailing Address - Fax:419-294-2946
Practice Address - Street 1:714 N SANDUSKY AVE
Practice Address - Street 2:
Practice Address - City:UPPER SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:43351
Practice Address - Country:US
Practice Address - Phone:419-294-9490
Practice Address - Fax:419-294-2946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2412111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2201647Medicaid
OH=========00OtherBWC
OH2201647Medicaid
OH2201647Medicaid