Provider Demographics
NPI:1104837830
Name:NATURAL MEDICINE,LLC
Entity Type:Organization
Organization Name:NATURAL MEDICINE,LLC
Other - Org Name:ASHVILLE CHIROPRACTIC AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-983-3500
Mailing Address - Street 1:3368 STATE ROUTE 752
Mailing Address - Street 2:
Mailing Address - City:ASHVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43103-9009
Mailing Address - Country:US
Mailing Address - Phone:740-983-3500
Mailing Address - Fax:
Practice Address - Street 1:3368 STATE ROUTE 752
Practice Address - Street 2:SUITE 1
Practice Address - City:ASHVILLE
Practice Address - State:OH
Practice Address - Zip Code:43103
Practice Address - Country:US
Practice Address - Phone:740-983-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2634111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNA9363391Medicare PIN