Provider Demographics
NPI:1235996539
Name:WESTERN RESERVE CHIROPRACTIC & ACUPUNCTURE
Entity Type:Organization
Organization Name:WESTERN RESERVE CHIROPRACTIC & ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRUMPAK
Authorized Official - Suffix:III
Authorized Official - Credentials:(DC, DABCO, DABCA)
Authorized Official - Phone:330-757-1151
Mailing Address - Street 1:1714 BOARDMAN POLAND RD STE 1
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-1957
Mailing Address - Country:US
Mailing Address - Phone:330-757-1151
Mailing Address - Fax:330-757-6687
Practice Address - Street 1:1714 BOARDMAN POLAND RD STE 1
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-1957
Practice Address - Country:US
Practice Address - Phone:330-757-1151
Practice Address - Fax:330-757-6687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty