Provider Demographics
NPI:1043472657
Name:DELLIQUADRI CHIROPRACTIC CLINIC, LCC, INC.
Entity Type:Organization
Organization Name:DELLIQUADRI CHIROPRACTIC CLINIC, LCC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:DELLIQUADRI
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:330-788-1086
Mailing Address - Street 1:703 E MIDLOTHIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44502-2504
Mailing Address - Country:US
Mailing Address - Phone:330-788-1086
Mailing Address - Fax:
Practice Address - Street 1:703 E MIDLOTHIAN BLVD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44502-2504
Practice Address - Country:US
Practice Address - Phone:330-788-1086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2350111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty