Provider Demographics
NPI:1205029808
Name:PAINESVILLE FAMILY CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:PAINESVILLE FAMILY CHIROPRACTIC INC.
Other - Org Name:PAINESVILLE FAMILY CHIROPRACTIC INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-639-9171
Mailing Address - Street 1:1640 MENTOR AVE
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-1707
Mailing Address - Country:US
Mailing Address - Phone:440-639-9171
Mailing Address - Fax:440-639-9071
Practice Address - Street 1:1640 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-1707
Practice Address - Country:US
Practice Address - Phone:440-639-9171
Practice Address - Fax:440-639-9071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2653111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9357121Medicare PIN