Provider Demographics
NPI:1063683811
Name:CHIROPRACTIC HEALTH & REHABILITATION, INC.
Entity Type:Organization
Organization Name:CHIROPRACTIC HEALTH & REHABILITATION, INC.
Other - Org Name:LORAIN ROAD HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:KLYCZEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-777-3595
Mailing Address - Street 1:24767 LORAIN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-2070
Mailing Address - Country:US
Mailing Address - Phone:440-777-3595
Mailing Address - Fax:440-777-3664
Practice Address - Street 1:24767 LORAIN RD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-2070
Practice Address - Country:US
Practice Address - Phone:440-777-3595
Practice Address - Fax:440-777-3664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2535797Medicaid
OH4012621Medicare PIN