Provider Demographics
NPI:1205389467
Name:HEALTH ACADEMY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:HEALTH ACADEMY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GREER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-984-0100
Mailing Address - Street 1:9797 MONTGOMERY RD STE A
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45242-7240
Mailing Address - Country:US
Mailing Address - Phone:513-984-0100
Mailing Address - Fax:513-283-8989
Practice Address - Street 1:9797 MONTGOMERY RD
Practice Address - Street 2:SUITE A
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-7247
Practice Address - Country:US
Practice Address - Phone:513-984-0100
Practice Address - Fax:513-283-8989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-24
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3686111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0182649Medicaid
OH0182649Medicaid