Provider Demographics
NPI:1013004514
Name:BEAVERCREEK CHIROPRACTIC & INJURY TREATMENT CTR., INC.
Entity Type:Organization
Organization Name:BEAVERCREEK CHIROPRACTIC & INJURY TREATMENT CTR., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-427-2225
Mailing Address - Street 1:3060 DAYTON XENIA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-6308
Mailing Address - Country:US
Mailing Address - Phone:937-427-2225
Mailing Address - Fax:937-431-1722
Practice Address - Street 1:3060 DAYTON XENIA RD
Practice Address - Street 2:SUITE A
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-6308
Practice Address - Country:US
Practice Address - Phone:937-427-2225
Practice Address - Fax:937-431-1722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2227111N00000X
OHPT006681225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBE9322921Medicare PIN
OHBE9329721Medicare PIN