Provider Demographics
NPI:1093997629
Name:INFIELD CHIROPRACTIC OFFICE, INC.
Entity Type:Organization
Organization Name:INFIELD CHIROPRACTIC OFFICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:INFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-224-0680
Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44048-0062
Mailing Address - Country:US
Mailing Address - Phone:440-224-0680
Mailing Address - Fax:440-224-2888
Practice Address - Street 1:6177 LAKE STREET
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44048
Practice Address - Country:US
Practice Address - Phone:440-224-0680
Practice Address - Fax:440-224-2888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH694111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000130893OtherANTHEM BLUE CROSS AND BLUE SHIELD
OH0346281Medicaid
44-00148OtherUNITED HEALTHCARE
868244OtherAETNA
OH0346281Medicaid