Provider Demographics
NPI:1154507010
Name:ROEDIGER CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:ROEDIGER CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROEDIGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-285-0756
Mailing Address - Street 1:401 SOUTH ST BLDG 2A
Mailing Address - Street 2:VILLAGE STATION
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-2805
Mailing Address - Country:US
Mailing Address - Phone:440-285-0756
Mailing Address - Fax:440-285-8625
Practice Address - Street 1:401 SOUTH ST BLDG 2A
Practice Address - Street 2:VILLAGE STATION
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-2805
Practice Address - Country:US
Practice Address - Phone:440-285-0756
Practice Address - Fax:440-285-8625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1811111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9324171Medicare PIN