Provider Demographics
NPI:1164505418
Name:DATTILO CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:DATTILO CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:DATTILO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-947-8970
Mailing Address - Street 1:810 OHIO PIKE STE B
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-2219
Mailing Address - Country:US
Mailing Address - Phone:513-947-8970
Mailing Address - Fax:513-947-8972
Practice Address - Street 1:810 OHIO PIKE STE B
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-2219
Practice Address - Country:US
Practice Address - Phone:513-947-8970
Practice Address - Fax:513-947-8972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3155111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSP01831Medicare ID - Type UnspecifiedGROUP NUMBER