Provider Demographics
NPI:1235369711
Name:NORTHCOAST INJURY & REHAB
Entity Type:Organization
Organization Name:NORTHCOAST INJURY & REHAB
Other - Org Name:OAKLAND PARK INJURY & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:STACY
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:614-268-8560
Mailing Address - Street 1:3278 MAIZE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-3207
Mailing Address - Country:US
Mailing Address - Phone:614-268-8560
Mailing Address - Fax:614-268-8963
Practice Address - Street 1:3278 MAIZE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-3207
Practice Address - Country:US
Practice Address - Phone:614-268-8560
Practice Address - Fax:614-268-8963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3556261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center