Provider Demographics
NPI:1033395439
Name:PHILLIP B. DOUDNA, D.C., LLC
Entity Type:Organization
Organization Name:PHILLIP B. DOUDNA, D.C., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:B
Authorized Official - Last Name:DOUDNA
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LLC
Authorized Official - Phone:614-875-1121
Mailing Address - Street 1:4305 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-3017
Mailing Address - Country:US
Mailing Address - Phone:614-875-1121
Mailing Address - Fax:614-875-1111
Practice Address - Street 1:4305 BROADWAY
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-3017
Practice Address - Country:US
Practice Address - Phone:614-875-1121
Practice Address - Fax:614-875-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1397261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0877538Medicaid
OH4243001Medicare UPIN