Provider Demographics
NPI:1104037902
Name:CHEATLE CHIROPRACTIC & REHAB CENTER
Entity Type:Organization
Organization Name:CHEATLE CHIROPRACTIC & REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHEATLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-833-7007
Mailing Address - Street 1:2315 LINCOLN WAY E
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-7063
Mailing Address - Country:US
Mailing Address - Phone:330-833-7007
Mailing Address - Fax:330-833-7541
Practice Address - Street 1:2315 LINCOLN WAY E
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-7063
Practice Address - Country:US
Practice Address - Phone:330-833-7007
Practice Address - Fax:330-833-7541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2715111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2068499Medicaid
OHCH9330781Medicare ID - Type Unspecified
OH2068499Medicaid