Provider Demographics
NPI:1114197779
Name:PATRICK J MCCLUSKEY DC INC
Entity Type:Organization
Organization Name:PATRICK J MCCLUSKEY DC INC
Other - Org Name:TIMBER RIDGE NECK & BACK PAIN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLUSKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-884-0083
Mailing Address - Street 1:9257 W SPRAGUE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-1208
Mailing Address - Country:US
Mailing Address - Phone:440-884-0083
Mailing Address - Fax:
Practice Address - Street 1:9257 W SPRAGUE RD
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-1208
Practice Address - Country:US
Practice Address - Phone:440-884-0083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH350040559Medicaid
OH000000121631OtherANTHEM BLUE CROSS BLUE SH
OH9296971Medicare PIN