Provider Demographics
NPI:1073664975
Name:ADVANCED PAIN RELIEF & WELLNESS CENTER
Entity Type:Organization
Organization Name:ADVANCED PAIN RELIEF & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-896-8500
Mailing Address - Street 1:2828 S ARLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-4716
Mailing Address - Country:US
Mailing Address - Phone:330-896-8500
Mailing Address - Fax:330-245-1729
Practice Address - Street 1:2828 S ARLINGTON RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-4716
Practice Address - Country:US
Practice Address - Phone:330-896-8500
Practice Address - Fax:330-245-1729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1411111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHGA0486661Medicare UPIN
OHUN050974Medicare UPIN
OHLO0634222Medicare UPIN