Provider Demographics
NPI:1073711297
Name:WEST BROAD INJURY & REHAB CENTER
Entity Type:Organization
Organization Name:WEST BROAD INJURY & REHAB CENTER
Other - Org Name:TRI-COUNTY INJURY & REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SCHEETZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-367-1203
Mailing Address - Street 1:7634 SLATE RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-8159
Mailing Address - Country:US
Mailing Address - Phone:614-367-1203
Mailing Address - Fax:614-367-1204
Practice Address - Street 1:7634 SLATE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-8159
Practice Address - Country:US
Practice Address - Phone:614-367-1203
Practice Address - Fax:614-367-1204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3331111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000355650OtherANTHEM
OH13670065500OtherOHIO BUREAU OF WORKERS CO
61129230OtherOWCP
OH11323783OtherCAQH
OH2353288Medicaid
OH7109596OtherAETNA
OH0000227811403OtherUNITED HEALTHCARE
645548OtherOPTUM HEALTH
OH=========OtherOSU CORESOURCE
OH=========-0003OtherMEDICAL MUTUAL
=========027OtherCARESOURCE