Provider Demographics
NPI:1225236987
Name:CHARLTON CHIROPRACTIC & WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:CHARLTON CHIROPRACTIC & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCHILLIG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-829-1962
Mailing Address - Street 1:22752 HARRISBURG WESTVILLE RD
Mailing Address - Street 2:STE A
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-9224
Mailing Address - Country:US
Mailing Address - Phone:330-829-1962
Mailing Address - Fax:330-829-9875
Practice Address - Street 1:22752 HARRISBURG WESTVILLE RD
Practice Address - Street 2:STE A
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-9224
Practice Address - Country:US
Practice Address - Phone:330-829-1962
Practice Address - Fax:330-829-9875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-04
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2754111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH28968565002OtherMEDICAL MUTUAL ID NUMBER
OH000000204822OtherANTHEM ID NUMBER
OH28968565000OtherBWC NUMBER
OH2092506Medicaid
OHU75447Medicare UPIN
OH2092506Medicaid