Provider Demographics
NPI:1144381732
Name:ST MARYS CHIROPRACTIC OFFICES
Entity Type:Organization
Organization Name:ST MARYS CHIROPRACTIC OFFICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:E
Authorized Official - Last Name:SPIELES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-394-4313
Mailing Address - Street 1:1297 E SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-2406
Mailing Address - Country:US
Mailing Address - Phone:419-394-4313
Mailing Address - Fax:419-394-2364
Practice Address - Street 1:1297 E SPRING ST
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885-2406
Practice Address - Country:US
Practice Address - Phone:419-394-4313
Practice Address - Fax:419-394-2364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0712090Medicaid
OH9301811Medicare PIN