Provider Demographics
NPI:1194823658
Name:ELYRIA CHIROPRACTIC SERVICES INC
Entity Type:Organization
Organization Name:ELYRIA CHIROPRACTIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BEDOCS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-365-8323
Mailing Address - Street 1:136 WINCKLES STREET
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-6152
Mailing Address - Country:US
Mailing Address - Phone:440-365-8323
Mailing Address - Fax:440-365-8324
Practice Address - Street 1:136 WINCKLES STREET
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-6152
Practice Address - Country:US
Practice Address - Phone:440-365-8323
Practice Address - Fax:440-365-8324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH265111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
30144353400OtherMEDICAL MUTUAL OF OHIO
0651103OtherAETNA LIFE INSURANCE COMP
4400203OtherUNITED HEALTHCARE
000000127998OtherANTHEM BLUE CROSS BLUE SH
OH30144353400OtherOHIO BUREAU OF WORKERS CO
0004382094OtherAETNA HEALTHCARE
4400203OtherUNITED HEALTHCARE
OH30144353400OtherOHIO BUREAU OF WORKERS CO
0651103OtherAETNA LIFE INSURANCE COMP