Provider Demographics
NPI:1033413448
Name:CROSSROADS CHIROPRACTIC AND WELLNESS
Entity Type:Organization
Organization Name:CROSSROADS CHIROPRACTIC AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPOBIANCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-694-1695
Mailing Address - Street 1:11201 STATE ROUTE 800 NE STE D
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:OH
Mailing Address - Zip Code:44643-8322
Mailing Address - Country:US
Mailing Address - Phone:330-694-1695
Mailing Address - Fax:
Practice Address - Street 1:11201 STATE ROUTE 800 NE STE D
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:OH
Practice Address - Zip Code:44643-8322
Practice Address - Country:US
Practice Address - Phone:330-694-1695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2811111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9392681Medicare PIN