Provider Demographics
NPI:1164577334
Name:FAMILY HEALTH CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:FAMILY HEALTH CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:KOINOGLOU
Authorized Official - Suffix:
Authorized Official - Credentials:DC, FIAMA, DIPL AC
Authorized Official - Phone:330-821-4455
Mailing Address - Street 1:641 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-4913
Mailing Address - Country:US
Mailing Address - Phone:330-821-4455
Mailing Address - Fax:
Practice Address - Street 1:641 E STATE ST
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-4913
Practice Address - Country:US
Practice Address - Phone:330-821-4455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2364409Medicaid
OH0886297Medicaid
OHFA9275291OtherMEDICARE PTAN
OH000000176741Medicaid
OH000000139080OtherBC/BS
OH733297Medicaid
OH350050794OtherRAILROAD MEDICARE
OH0886297Medicaid
OH000000139080OtherBC/BS
OH2364409Medicaid
OH000000139080OtherBC/BS