Provider Demographics
NPI:1033414859
Name:CROSSROADS CHIROPRACTIC AND WELLNESS, LLC
Entity Type:Organization
Organization Name:CROSSROADS CHIROPRACTIC AND WELLNESS, LLC
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
Mailing Address - Street 2:SUITE D
Mailing Address - City:MAGNOLIA
Mailing Address - State:OH
Mailing Address - Zip Code:44643-8322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11201 STATE ROUTE 800 NE
Practice Address - Street 2:SUITE C
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:2011-01-26
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty