Provider Demographics
NPI:1174821466
Name:ROCKSIDE HEALTH & WELLNESS, LLC
Entity Type:Organization
Organization Name:ROCKSIDE HEALTH & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CAPOBIANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-268-6659
Mailing Address - Street 1:6500 ROCKSIDE RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2368
Mailing Address - Country:US
Mailing Address - Phone:216-447-9704
Mailing Address - Fax:216-447-9708
Practice Address - Street 1:6500 ROCKSIDE RD
Practice Address - Street 2:SUITE 160
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2368
Practice Address - Country:US
Practice Address - Phone:216-447-9704
Practice Address - Fax:216-447-9708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty