Provider Demographics
NPI:1184856668
Name:MIDDLETOWN CHIROPRACTIC AND REHABILITATION CENTER
Entity Type:Organization
Organization Name:MIDDLETOWN CHIROPRACTIC AND REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-217-7676
Mailing Address - Street 1:2714 N VERITY PKWY
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-2408
Mailing Address - Country:US
Mailing Address - Phone:513-217-7676
Mailing Address - Fax:
Practice Address - Street 1:2714 N VERITY PKWY
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-2408
Practice Address - Country:US
Practice Address - Phone:513-217-7676
Practice Address - Fax:513-217-6464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-17
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty